[LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR KIDNEY TUMORS R.E.N.A.L. SCORE 10 and HIGHER]

OBJECTIVE: To discuss the feasibility, safety, and effectiveness of conventional laparoscopic partial nephrectomy for patients with kidney tumors R.E.N.A.L. score 10 and higher. MATERIALS AND METHODS: Retrospective comparative study. Everyone who has been treated from I 2015 to I 2020 by one surgeon in our department by lap partial nephrectomy was included. Patients were randomized by criteria of R.E.N.A.L. score in two groups: 40 those who had this index 10 or more ("R10+"), and 69 - all the rest ("R less or equal 9"). Perioperative factors and results were studied and compared. Video presentation of the surgical technique is available at: https://youtu.be/1254WSFMxJ0. RESULTS: No conversions to open surgery or nephrectomy & any complications Clavien >III were detected. Of all patients, benign lesions were identified in 21(19,3%). Up stage from 1-2 to 3 occurred in 6 (6,82%) cases. Intraop complications: 4,3% vs 2,5% (p=0,6) and the same values of postop Clavien III rate for "R less or equal 9" & "R10+" groups respectively. There were no any significant differences between the two groups except for three parameters: OR time, estimated blood loss & warm ischemia time. In "R10+" cohort these values were 170 [130; 210] min, 250 [162; 337] ml & 20,1+/-5,7 min. And in "R less or equal 9" - 130 [100; 180] min, 200 [150; 300] ml & 15,9+/-4,5 min respectively (p<0.05 for all). Oncological results were comparable and nephrometric index had no effect on them. CONCLUSION: conventional lap partial nephrectomy is safe and efficient even in cases of complex tumors with R.E.N.A.L. score 10 and higher.

[Laparoscopic ureteral substitution: ileocalicostomy combined with psoas hitch].

A 50-year-old female presented to our department of urology with nephrostomy drain in the right kidney been placed because of an acute obstructive pyelonephritis. Nephrostogram revealed an intra-renal pelvis with no passage of contrast into the ureter. Retrograde pyelography identified the extended ureteric stricture and need for a substitution. Laparoscopic ileocalicostomy was performed to achieve a communication between the lower calyx and bladder. Video describing surgical technique is available on https://youtu.be/bIW_m3lwXWY. Due to thick and full-blooded renal parenchyma, a partial nephrectomy of the lower pole had to perform to get an access to the renal calyx. It took 25 min of warm ischemia. At that, sutures of renorrhaphy should have provided reliable hemostasis on the one hand, and free outflow of urine via an isolated calyx on the other. To reduce the length of ileoureter a bladder psoas hitch maneuver was used. A 25-cm-long segment of ileum was isolated and rotated in isoperistaltic manner. Double J stent was held through it. Ileocalicostomy by interrupted and ileovesicostomy by continuous sutures were performed one after another. There were no intraop complications. OR time - 300min. EBL - 200ml. Postoperative course was uneventful. Ten days after surgery, nephrostogram and cystography confirmed the patency of the neoureter and the tightness of both anastomoses. Nephrostomy drain was removed first, ureteral - one day after. "JJ" stood for 3 weeks. The patient is doing well at more than 12 months of follow-up with a stable renal and ileoureteral function. In comparison with open procedure our surgery is significantly less invasive, per contra robotic - not so expensive. As far as we known, this is the first case report of conventional laparoscopic intracorporeal ileocalicostomy with long-term good functional results demonstration.

[Laparoscopic segmental ureteral resection with ileal-ureter substitution for ureteral urothelial carcinoma].

Ureteral resection for the mid-ureter urothelial carcinoma is the operation of choice in patients with low-grade tumors. However, extensive excision within normal tissues may lead to difficulty in appropriate apposition of the ends of the ureter, while incomplete resection increases the risk of oncological progression. This article describes the first experience with laparoscopic segmental ureteral resection with the ileal - ureter substitution for mid-ureter urothelial carcinoma. In this case, a short non-reconfigurated segment of the ileum was interposed between the distal and proximal ends of the resected ureter. Operative time was 230 min, and blood loss was less than 100 ml. No complications were observed. The patients postoperative hospital stay was seven days. Follow-up examination 12 months after surgery showed no evidence of the disease progression and preserved normal renal function. The proposed method may be considered as an alternative treatment for carefully selected patients.

[Initial experience with laparoscopic anatrophic nephrolithotomy].

Percutaneous nephrolithotomy is a recognized standard for minimally invasive treatment of large kidney stones. Percutaneous interventions for complete staghorn stones are associated with a higher risk of complications that precludes abandoning the traditional open operations, one of which is an anatrophic nephrolithotomy. This paper presents the first personal experience in laparoscopic transmesenteric anatrophic nephrolithotomy. The intervention was conducted in 3 patients (2 males and 1 female) aged 43 to 58 years, having a primary symptomatic complete left kidney staghorn stones sized from 7.2 to 9.1 cm along the longitudinal axis. Operation time ranged from 130 to 170 minutes, kidney warm ischemia time - from 21 to 24 minutes, blood loss - from 180 to 250 ml. The staghorn stone was completely extracted in 2 patients. In one patient, a 0.8 cm residual stone was left in the completely excluded calix, since it caused none clinical symptoms and did not impair urinary flow. At this stage, the number of laparoscopic procedures for complete staghorn nephrolithiasis is too small to carry out an adequate statistical analysis and draw any definite conclusions. Nevertheless, the first experience demonstrated not only plausibility but also the effectiveness of such operations.