The effect of accelerated rehabilitation surgery on the perioperative period of laparoscopic radical nephrectomy / 中国实用护理杂志

Objective To explore the effect of accelerated rehabilitation surgical nursing on perioperative period of laparoscopic radical nephrectomy. Methods A total of 78 patients with laparoscopic radical nephrectomy in Heze City Hospital in Shandong Province from December 2015 to December 2017 were divided into research group and control group with 39 cases each by random digits table method. The control group was received traditional perioperative nursing intervention, the research group was given accelerate rehabilitation surgical nursing in addition to the traditional perioperative nursing. The indicators related to the operation, postoperative complications and postoperative Visual Analogue Scale (VAS) score were compared. In addition, the scores of Self-rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS) before and after nursing in the two groups were compared, and the nursing satisfaction rates of the two groups were compared. Results The first time to go out of bed, anus exhaust time, eating time, length of hospital stay, postoperative hospitalization expenses respectively was (4.82±0.43) h, (6.45±1.93) h, (2.53±0.41) h, (3.59±0.23) d, (3.12±0.15) ten thousand yuan in the research group, and (7.57±0.62) h, (32.67±14.59) h, (27.63±10.64) h, (8.54±0.52) d, (4.57±0.26) ten thousand yuan in the control group, with statistically significant differences between the two groups (t=-54.367--11.126, all P<0.01). The VAS score was (3.63 ± 0.29) points in the research group, and (7.52 ± 0.34) points in the control group, with statistically significant differences between the two groups (t=-54.362, P<0.01). The incidence of postoperative complications was 2.56％ (1/39) in the research group, and 10.26％ (4/39) in the control group, with statistically significant differences between the two groups (χ2=4.942, P<0.05). Before and after nursing, SAS and SDS scores was respectively (56.37±5.59), (42.35±2.89), (57.30±5.74), (43.09±3.25) points in the research group, and (56.49±5.70), (50.46±4.25), (57.23±5.68), (50.71±5.20) points in the control group, with statistically significant differences between the two groups (t=-9.854,-7.760, all P<0.01). The satisfaction rate of patients was 97.44％(38/39) in the research group, and 84.62％(33/39) in the control group, with statistically significant differences between the two groups (χ2=10.064, P<0.01). Conclusions For patients with laparoscopic radical renal resection, accelerate rehabilitation the use of surgical nursing is of great significance, to reduce the incidence of complications, shorten patients with postoperative hospital stay, reduce pain, eliminate the adverse psychological aspects and so on all play a positive role, further improve nursing satisfaction, promote the postoperative rehabilitation, clinical significance and application value.

Nefrectomía radical laparoscópica en angiomiolipoma renal con invasión de vena renal / Laparoscopic radical nephrectomy of angiomyolipoma with renal vein involvement

Background: Angiomyolipomas associated with tuberous sclerosis may invade the renal vein and generate intramural thrombi. Case report: We report a 36-years-old woman, consulting for left flank pain. CT scan showed a large tumor in the left kidney consistent with the diagnosis of infiltrating renal angiomyolipoma with tumor invasion of the vein. Laparoscopic nephrectomy was performed, with removal of tumor thrombus. The operative time was 127 minutes and estimated bleeding 20 ml. There were no intraoperative or postoperative complications. The patient is currently asymptomatic after 12 months of follow up. The pathological study of the surgical piece showed a renal angiomyolipoma with invasion of the kidney and a solid tumor in the lumen of the renal vein.

Objetivo: Se presenta el caso clínico de un Angiomiolipoma renal con extensión a vena renal, patología de muy baja frecuencia. Caso clínico: Mujer de 36 años, quien consulta por dolor en flanco izquierdo. En una tomografía computada se encuentra una lesión tumoral extensa del riñón izquierdo compatible con un Angiomiolipoma renal infiltrante e invasión tumoral de la vena renal. Se realiza nefrectomía laparoscópica, con extirpación de trombo tumoral. El tiempo operatorio fue de 127 min y el sangrado estimado de 20 ml. No hubo complicaciones intra ni postoperatorias. La paciente se encuentra actualmente asintomática luego de 12 meses de seguimiento. La histología mostró un Angiomiolipoma renal con invasión del riñón y un tumor sólido en el lumen de la vena renal. Conclusión: La invasión de vena renal por un Angiomiolipoma es extremadamente raro. Su resolución laparoscópica es posible, con sólo una comunicación previa en la literatura.

Laparoscopic radical nephrectomy and open radical nephrectomy for stage T2 renal cell carcinoma patients: A comparison of clinical outcomes / 第二军医大学学报

Objective: To compare the efficacy of laparoscopic radical nephrectomy(LRN) and open radical nephrectomy (ORN) for clinical stage T2 renal cell carcinoma. Methods: A total of 138 patients underwent radical nephrectomy for renal cell carcinoma, including 63 by LRN and 75 by ORN. Renal cell carcinoma was pathologically confirmed in all the patients. The patients were followed up for 5-36 months, with a median of 24 months. The surgical blood loss, operation time, and time of starting food postoperatively, and hospital stay were compared between the two groups. Results: The operation tíme was 90- 385 min (a mean of [213 ± 61. 6] min) for LRN and 55-320 min (a mean of [173 ± 52. 3] min)for ORN (P = 0. 000). The blood losswas 30-1 600 ml (a mean of [220±291. 8] ml) for LRN and 50-1 400 ml (a mean of [319 ±244. 1] ml) for ORN (P = 032). The fasting period of surgery was 1-4 d (a mean of [2. 4±0. 82] d) for LRN and 2-5 d (amean of [3. 1±1. 02] d) for ORN(P = 0. 000). The hospital stay was 4-15 d (a mean of [7. 3±2. 50] d) for LRN and 6-15 d (amean of [9. 3±2. 25] d) for ORN (P = 0. 000). Conclusion: The efficacy of LRN is similar to that of ORN. LRN has the advantages of minimal invasiveness and rapid postoperative recovery. The complication of LRN is similar to ORN, and it might be an alternative treatment for clinical T2 stage renal cell carcinomas.

Transperitoneal versus retroperitoneal laparoscopic radical nephrectomy: A comparison of clinical outcomes / 第二军医大学学报

To compare clinical outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma (RCC) and to identify the indicators for each approach. Methods A total of 258 patients underwent transperitoneal(n=116) or retroperitoneal (n=142) laparoscopic radical nephrectomy for RCC. The operation time, blood loss during operation, fasting period after surgery and hospital stay were compared between the two groups. Results The operation time was 80-315 min(a mean of [167±66.8] min) for transperitoneal approach and 85-280 min(a mean of [152± 48.8] min) for retroperitoneal approach (P=0.034). The blood loss was 50-1,000 ml (a mean of [181±140.4] ml) for transperitoneal approach and 50-800 ml(a mean of [171±132.9] ml) for retroperitoneal approach(P=0.544). The fasting period of surgery was 1-5 d (a mean of [2.8±1.3] d) for transperitoneal approach and 1-5 d (a mean of [2.9±1.2] d) for retroperitoneal approach(P=0.801). The hospital stay was 3-9 d (a mean of [6.6±1.5] d) for transperitoneal approach and 3-8 d (a mean of [6.5±1.6] d) for retroperitoneal approach(P = 0. 477). Conclusion Transperitoneal and retroperitoneal approaches both can yield satisfactory surgical outcomes in laparoscopic radical nephrectomy. The transperitoneal approach is suitable for tumors with a larger size.

Transperitoneal versus retroperitoneal laparoscopic radical nephrectomy: A comparison of clinical outcomes / 第二军医大学学报

Objective To compare clinical outcomes of transperitoneal and retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma (RCC) and to identify the indicators for each approach. Methods A total of 258 patients underwent transperitoneal (n = 116) or retroperitoneal (n = 142) laparoscopic radical nephrectomy for RCC. The operation time, blood loss during operation, fasting period after surgery and hospital stay were compared between the two groups. Results The operation timewas 80-315 min (a mean of [167 ±66. 8] min) for transperitoneal approach and 85-280 min (a mean of [152± 48.8] min) for retroperitoneal approach (P = 0. 034). The blood loss was 50-1,000 ml (a mean of [181±140. 4] ml) for transperitoneal approach and 50-800 ml (a mean of [171 ± 132. 9] ml) for retroperitoneal approach(P = 0. 544). The fasting period of surgery was 1-5 d (a mean of [2. 8±1. 3] d) for transperitoneal approach and 1-5 d (a mean of [2. 9 ±1. 2] d) for retroperitoneal approach(P = 0. 801). The hospital stay was 3-9 d (a mean of [6. 6±1. 5] d) for transperitoneal approach and 3-8 d (a mean of [6. 5±1. 6] d) for retroperitoneal approach(P = 0. 477). Conclusion Transperitoneal and retroperitoneal approaches both can yield satisfactory surgical outcomes in laparoscopic radical nephrectomy. The transperitoneal approach is suitable for tumors with a larger size.

Videomimicography in displaying skills of retroperitoneal laparoscopic radical nephrectomy in a self control manner / 第二军医大学学报

Objective: To use videomimicography to display the skills of retroperitoneal laparoscopic radical nephrectomy in a self control manner, so as to help the beginners to learn the skills quickly. Methods: The videos of 147 cases of retroperitoneal laparoscopic radical nephrectomy for renal-cell carcinomas (T1 N0 M0), which were performed by a surgeon in our department from Jan. 1, 2002 to Dec. 31, 2006, were retrospectively analyzed. The first 30 cases were compared with the last 30 cases in terms of operative manipulation, outcomes, problems in operation, and complications after operation. The difficulties in learning retroperitoneal laparoscopic radical nephrectomy from videos were discussed. Results: There were no differences between the two patient groups in age, gender, the location or size of the tumors. The bleeding volumes, operation time, frequencies of transferring to open surgery, and addition of Trocar in the first 30 patients were significantly more than those in the last 30 patients (all P<0.01). Results of videomimicography demonstrated that the beginners had a poor anatomic knowledge, the exposure and tissue isolation were not enough, and they had a poor basic skill in manipulating laparoscope. Conclusion: Videomimicography can better display the difficulties in retroperitoneal laparoscopic radical nephrectomy in a self control manner, which can help the beginner to understand the operating skills; the method is worth popularizing.

The Early Experience of Laparoscopic Radical Nephrectomy: Laparoscopic versus Open Radical Nephrectomy / 대한비뇨기과학회지

PURPOSE: The laparoscopic technique of a radical or total nephrectomy for renal masses and a radical nephroureterectomy for transitional cell carcinomas has recently gained rapid momentum as an effective method of extirpative surgery. We evaluated our experience of laparoscopic radical nephrectomy (LRN) and compared the results to those of contemporary series of open radical nephrectomy (ORN) in renal cell carcinomas. MATERIALS AND METHODS: Eight males and 5 females underwent a LRN for suspicious renal cell carcinomas. The operations were performed via a transperitoneal route. We retrospectively evaluated the efficacy of the LRN compared to a contemporary group of 13 patients who underwent an ORN for renal cell carcinomas. RESULTS: For the same period, the results of the LRN (13 patients) and the ORN (13 patients) were compared, and no significant differences were found in: body mass index (24.7 versus 22.8kg/m2, p=0.08), specimen weight (377 versus 431gm, p>0.1) or mass size (3.7 versus 4.4cm, p>0.1). The LRN group had significantly reduced estimated blood losses (433 versus 866ml, p=0.01), pain medication requirements (145 versus 225mg, p=0.04) and times to ambulate (19 versus 32 hours, p=0.02). The operating time, however, was much longer in the LRN compared to the ORN (284 versus 193 min., p=0.09) group. CONCLUSIONS: Although a LRN has a longer operation time, it has similar efficacy, and is more tolerated by patients than an ORN. Thus, LRN may be a viable alternative for managing localized renal tumors.