Use of water jet resection in organ-sparing kidney surgery.

BACKGROUND AND PURPOSE: The morbidity of organ-sparing renal surgery is related to intraoperative hemorrhaging and secondarily to urinary fistulae and urinoma. Various tools have been developed for gentle transection and precise control of bleeding. Water jet technology is already established in clinical practice for surgery of the liver and other parenchymatous organs. We report our clinical experience with a new water jet resection device in kidney surgery and the histologic effects of water jet resection on kidney tissue. PATIENTS AND METHODS: A series of 24 patients underwent open surgery for renal-cell carcinoma, nephrolithiasis, complicated cysts, or oncocytoma. In tumor patients, a partial nephrectomy; in two stone patients, a nephrolithotomy; and in the third stone patient, a lower-pole resection were performed. The cysts and the oncocytoma were enucleated in toto. In one patient, an endoscopic pyeloplasty was performed because of ureteropelvic stenosis. Tissue samples were investigated histologically using standard light microscopy after hematoxylin-eosin staining and compared with those subjected to thermal dissection techniques. RESULTS: The water jet produced a corridor in the desired dissection line without interfering with the intrarenal vessels and pelvicalical system. This way, precise hemostasis was possible, and damages to the surrounding tissue was avoided. Resection took between 14 and 40 minutes with minimal intraoperative blood loss. No significant postoperative complications occurred. Histologic evaluation demonstrated a sharp dissection line without thermal alterations or deep necrosis. Only a small disruption zone could be seen at the margins of the dissection. CONCLUSIONS: Water jet resection is a gentle method for dissection of kidney tissue. Histologic examination confirmed minimal traumatic parenchymal alteration. In our opinion, the water jet dissector is a useful device for renal transection in organ-sparing kidney surgery.

Use of water jet resection in renal surgery: early clinical experiences.

OBJECTIVE: Various surgical techniques have been developed to reduce the risk of bleeding during dissection of renal tissue. Water jet technology has been designed for a gentle transection of parenchymal organs. We report about first experiences with a new water jet resection device in kidney surgery. METHODS: 7 patients underwent open surgery because of renal cell carcinoma or nephrolithiasis. In tumor patients a partial nephrectomy, in 1 stone patient a nephrolithotomy, and in the other 1 a lower pole resection were performed. RESULTS: By means of water jet resection tissue was dissected effectively avoiding damage to the vascular structures, which were then ligated selectively. Resection time was between 14 and 30 min with a minimal intraoperative blood loss. No significant problem was seen postoperatively. CONCLUSIONS: The results demonstrate that water jet technology is an applicable tool for transection of renal parenchyma. It has been shown to reduce the risk of blood loss significantly compared to other techniques.

Ceftazidime concentrations in renal cysts.

Levels of ceftazidime (CAZ) in uninfected renal cysts of 25 patients were investigated. Seventeen patients received 2 g CAZ about 140 min prior to puncture of the cysts (group I), and eight patients were treated with 2 x 2 g CAZ one day before, and with a further dose of 2 g 2 h prior to puncture (group II). In eight cases (two of group I and six of group II) the concentration of the cyst fluid was also assessed at 4 h and 6 h after completion of the CAZ infusion. In group I, CAZ concentrations were 0.5 to 1.13, micrograms ml-1, mean 0.71; in group II CAZ concentrations were 3.6 to 6.7 micrograms ml-1, mean 5.55. At 4 h and 6 h after infusion the mean cyst concentrations were 4.4 and 2.9 micrograms ml-1, respectively.

[Selective embolization of the internal iliac artery: last resort in inoperable hemorrhaging prostatic cancer]. / Selektive Embolisation der Arteriae iliacae internae: Ultima ratio bei blutendem inoperablem Prostatakarzinom.

A case of profuse hemorrhage from prostatic carcinoma infiltrating the urinary bladder is presented. Angiography was performed to identify the vascular supply. Selective embolization of the internal iliac arteries is described, potential complications are discussed.