Comparison of Intraoperative Results of Simple Open and Laparoscopic Nephrectomies in the Treatment of Benign Renal Pathologies in a First-Level Center in Mexico City.

OBJECTIVES: To assess the efficacy and safety of simple open versus laparoscopic nephrectomies for treating benign renal pathologies, with a focus on comparing the prevalence of surgical complications at a first-level center in Mexico City. METHODS: A retrospective analysis spanning 2010-2020 was conducted where all patients undergoing simple nephrectomy for benign conditions were included and stratified into open and laparoscopic surgery groups. Variables analyzed included urological history, laboratory findings, surgical outcomes, complications, and histopathological results. Statistical comparisons employed Student's t-test for means and the chi-square test for frequencies. Additionally, binary logistic regression was utilized to identify predictors associated with conversion from laparoscopic to open surgery. RESULTS: The laparoscopic approach showed significant advantages in intraoperative bleeding (p=0.008) and intensive care unit stay (p=0.04). The conversion rate from laparoscopic to open surgery was 19.23%, with no significant risk factors identified for conversion. CONCLUSIONS: Laparoscopic simple nephrectomy proves to be a secure and effective method in specialized urological centers with skilled surgeons, offering superior intraoperative outcomes compared to open surgery. It effectively reduces intraoperative hemorrhage, minimizes blood transfusion needs, and shortens hospital stays. Nonetheless, challenges such as equipment availability, costs, and surgeon expertise must be addressed. Further research focused on postoperative complications is crucial to advocate for broader adoption of laparoscopic nephrectomy as the preferred standard for treating relevant urological conditions, emphasizing substantial advantages over traditional open approaches.

Renal Cell Carcinoma With Tumor Thrombus: A Case Series in Puerto Rico.

INTRODUCTION:  Renal cell carcinoma (RCC) is one of the most common types of kidney cancer. While RCC tends to present as a localized tumor, a notable proportion may present with distant metastasis. In some instances, RCC may also present with intravascular tumor extension, often called tumor thrombus (TT). Its presence confers a worse prognosis and has important implications for the tumor's staging and treatment. Despite extensive documentation of RCC TT in the US, limited data exists regarding its presentation, management, and outcomes in Puerto Rico (PR). This study aims to broaden the available information on RCC TT, emphasizing surgical management and outcomes. We also provide descriptive data on patient demographics and clinical presentation to improve decision-making among clinicians caring for Puerto Rican men and women. METHODS:  In this single-center, retrospective study, we evaluated patients who underwent partial or total nephrectomy at Saint Luke's Episcopal Medical Center between 2018 and 2022. Data was abstracted from electronic health records (EHR). Patients without documented evidence of TT during the peri-operative period were excluded from the study. A total of 220 patient records were evaluated, of which 12 met the inclusion criteria for the study. Cases were categorized using the latest RCC TT guidelines. Central tendency measurements were used to describe the sample distribution. The mean was considered to make assumptions regarding the prevalent observations, and the median was considered to rule out possible outliers. Categorical data were evaluated using proportion analyses, including TT extension level and BMI variables. Fisher's exact test evaluated the association between the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade and TT extension level. RESULTS:  Most patients lacked TT-related symptoms. The most severe presenting symptom was a pulmonary embolism (8.3%). Hypertension (83.3%), BMI greater than 25 at the time of diagnosis (75%), and type 2 diabetes mellitus (66.7%) were the most common comorbid conditions within our cohort. Nearly 75% of patients underwent laparoscopic radical nephrectomy with TT resection. One left-sided level III case was managed by laparoscopic-assisted open radical nephrectomy with a right subcostal incision. There were zero intraoperative complications and two postoperative complications. The histopathological reports of all cases were consistent with clear cell carcinoma, and half of the cases (n=6) were WHO/ISUP G4. All patients are alive and free of disease. CONCLUSION:  RCC is a common renal neoplasm in PR that can present with intravascular tumor extension. Our findings do not establish a definitive association between BMI, tumor size, WHO/ISUP grading, and TT extension level. Our study shows that laparoscopic removal of RCC TT is a safe and effective approach. However, the generalizability of our findings is limited by the study's design and sample size. Future research should focus on identifying predictive markers, establishing effective screening protocols, and determining if our hybrid approach has comparable outcomes to the standard open approach.

Laparoscopic nephrectomy in patients with renal exclusion secondary to urolithiasis. Which factors can predispose conversion to open surgery?

BACKGROUND: The prevalence of urolithiasis is 7-10% and has increased over the past years. Simple nephrectomy is, therefore, indicated when renal exclusion is associated with recurrent urinary tract infections and/or chronic pain. OBJECTIVE: The aim of the study was to describe the surgical experience of laparoscopic nephrectomy (LPN) due to urolithiasis in Mexican South-east and which factors can predispose conversion to open surgery. METHODS: This was a retrospective study including patients with renal exclusion secondary to urolithiasis, who underwent laparoscopic simple nephrectomy between 2016 and 2019. RESULTS: Forty simple LPN for renal exclusion due to urolithiasis was performed between 2016 and 2019. Mean age was 47 ± 10.8 and 82.5% were female. The mean BMI was 30.2 ± 5 kg/m2, mean operative time was 165.2 ± 64. Conversion rate was 12.5% (n = 5). Conversion was significantly associated with abnormal hilum vascular anatomy (p = 0.001), hilum adherences (p = 0.001), and hydronephrosis (p = 0.001). CONCLUSION: LPN is a safe surgical technique for renal exclusion due to urolithiasis. Hydronephrosis, abnormal vascular anatomy, and the adherences that involved de hilum are the factors that could predictive conversion to open surgery.

INTRODUCCIÓN: La prevalencia the urolitiasis es del 7-10% sin embargo a presentado un incremento del numero de casos en los ultimos años. La nefrectomia simple laparoscopica esta indicada en pacientes con exclusión renal asociado a cuadros repetitivos de infecciones en el tracto urinario y o dolor cronico a nivel fosa renal. OBJETIVO: Describir la experiencia de nefrectomia simple laparoscopica en pacientes con exclusion renal secundario litiasis en un hospital del sur de México, y que factores pueden predisponer la conversión a cirugia abierta. MATERIALS Y METODOS: Estudio restrospectivo que incluyo pacientes con exclusion renal secundario a urolitiasis durante el periodo comprendido entre 2016 y 2019. RESULTADOS: Se realizaron 40 nefrectomias simples laparoscopica durante el periodo comprendido 2016 y 2019 en paciente con exclusion renal asociada a litiasis. La media edad 47 ± 10.8 años, el 82.5% de los pacientes fueron del sexo femenino. La media de Indice de masa corporal fue de 30.2 ± 5 kg/m2, La tasa de conversion fue del 12.5% (n = 5), los factores que se asociaron a conversion a cirugia abierta fueron anormalidades dependientes del hilio vascular renal (p = 0.001)., adherencias dependientes del hilio renal (p = 0.001). e hidronefrosis (p = 0.001). CONCLUSIÓN: La nefrectomia simple laparocopica es un procedimiento seguro en pacienres con exclusion renal secundaria a urolitiasis. Hidronefrosis, anormalidades dependientes del hilio vascular renal y adherencias que involucren el hilio renal son factores que pueden predisponer conversion a cirugia abierta.

Safety and Intraoperative Results in Live Kidney Donors with Vascular Multiplicity After Hand-Assisted Laparoscopy Living Donor Nephrectomy.

BACKGROUND AND PURPOSE: Vascular multiplicity is the most frequent anatomic variation in kidney donors. Despite concerns about risks, these allografts are increasingly used to overcome the shortage of kidney donors. The safety and clinical outcomes in living kidney donors were evaluated with vascular multiplicity after hand-assisted laparoscopic living donor nephrectomy (HALDN). PATIENTS AND METHODS: Data from all living kidney donors who underwent HALDN from 2008 to 2021 was retrospectively reviewed. Patients were divided into two groups as single (SRV) and multiple renal vessels (MRV), and a comparative analysis was done. The primary outcomes include operating room time (ORT), days of hospital stay, estimated blood loss, complications, conversion, and re-operations. RESULTS: MRV were present in 166 out of 612 donors (27.1%). Among those, 10 (1.6%) donors had simultaneous multiple arteries and veins. Additionally, the prevalence of artery and vein multiplicity was 21.8% (n = 134) and 3.5% (n = 22), respectively. Warm ischemia time was significantly different among the two groups but not clinically important. The number of conversions to open technique, the mean ORT, the median blood loss, and days of hospital stay were similar between the SRV and MRV groups, without significant differences. According to the modified Clavien-classification system, no differences were found in the complication rates between the two groups (p = 0.29). Complication rates were 3.3% and 3.6% for the SRV and MRV groups, respectively. CONCLUSION: HALDN is a procedure with safe intraoperative results, even with vascular multiplicity. The presence of multiple renal arteries or veins has no negative impact on the outcome of the donor after living donor nephrectomy.

Recomendaciones en la analgesia perioperatoria para la nefrectomía laparoscópica / Recommendations in perioperative analgesia for laparoscopic nephrectomy

Resumen: La nefrectomía laparoscópica se ha convertido en el enfoque quirúrgico estándar en muchos centros de tratamiento quirúrgico para los tumores renales, así como de otras patologías. Los estudios que comparan la nefrectomía abierta y laparoscópica reportaron que la nefrectomía laparoscópica facilitó una recuperación más rápida con una menor morbilidad perioperatoria, menor pérdida sanguínea y produjo menos dolor. Sin embargo, algunos pacientes sometidos a una nefrectomía laparoscópica todavía experimentan dolor postoperatorio que requiere el uso de opiáceos parenterales. Dado que el abordaje es frecuentemente lumboscópico, la distensión y el dolor interno en ese sitio quirúrgico, las incisiones de los puertos, la nocicepción de los órganos y los cólicos ureterales en conjunto con las molestias urinarias asociadas al catéter urinario contribuyen al dolor postoperatorio. A pesar de que esta cirugía ha llegado a ser menos invasiva, el dolor se reporta de moderado a intenso (visita http://www.painoutmexico.com para obtener la versión completa del artículo y el diagrama de recomendaciones).

Abstract: Lumboscopic nephrectomy has become the standard surgical approach in many surgical treatment centers for renal tumours as well as other pathologies. Studies comparing open and laparoscopic nephrectomy reported that laparoscopic technique facilitated a faster recovery with lower peri-operative morbidity, lower blood loss, and produced less pain. However, some patients undergoing laparoscopic nephrectomy still experienced postoperative pain requiring parenteral opioids. Due to the surgical approach is often lumboscopic, the distension and pain at the inner surgical site, laparoscopic port sites and incision, organ nociception, and ureteric colic together with urinary tract discomfort associated with urinary catheter contributed to the postoperative pain. So even though this surgery has become less invasive, pain is reported from moderate to intense (visit http://www.painoutmexico.com to see the full article and recommendations).

Resultados del trasplante renal con donante vivo: análisis comparativo entre arteria renal única y múltiple / Outcome in Living Donor Kidney Transplant: Comparative Análisis of Single and Multiple Renal Arteries

Objetivos: Realizar un análisis comparativo de los resultados funcionales y complicaciones en trasplantados renales y sus respectivos donantes vivos con arteria renal única versus múltiple. Materiales y métodos: Trabajo retrospectivo analítico de una base de datos confeccionada prospectivamente de pacientes sometidos a trasplantes renales con donante vivo en nuestra institución entre mayo de 2010 y julio de 2014. Según el número de arterias presentes en la angiotomografía preoperatoria se confeccionaron dos grupos: grupo 1 (arteria renal única) y grupo 2 (arteria renal múltiple). Resultados: De los 91 pacientes incluidos, el 37% (n=34) presentaba arterias renales múltiples. Se realizó una nefrectomía laparoscópica al 63% (n=36) y el 41% (n=14) de los donantes del grupo 1 y el grupo 2, respectivamente (p=0,05). Tiempos promedio de isquemia total (grupo 1: 55,6 min; grupo 2: 56 min; p=0,931), de anastomosis (grupo 1: 29,6 min; grupo 2: 29,7 min; p=0,982) y de "cirugía de banco" (grupo 1: 23,5 min; grupo 2: 23,8 min; p=0,948). Transfusión de glóbulos rojos en los receptores (grupo 1: 7%; grupo 2: 14%; p=0,23). Porcentaje de hemodiálisis en la primera semana (grupo 1: 5,2%; grupo 2: 5,8%; p=1). No se hallaron diferencias significativas entre grupos a nivel de tasa de complicaciones y días de internación. Ambos grupos presentaron una sobrevida del injerto del 100% a los 35,6 meses de seguimiento promedio. Conclusiones: La presencia de multiplicidad arterial no debe ser considerada una contraindicación para el donante vivo, ya que el implante de estos injertos logra resultados funcionales similares a los injertos renales con arteria única, sin aumentar la morbilidad del procedimiento. (AU)

Objectives: TTo compare functional outcomes and complications in patients with a single artery versus multiple arteries undergoing living donor nephrectomy. Materials and methods: Retrospective analysis of a prospective collected database of living donor kidney transplantations performed at our institution between May 2010 and July 2014. According to the number of arteries present in preoperative angiotomography, two groups of patients were organized: group 1 (single artery) and group 2 (multiple arteries). Results: TNinety-one living donor kidney transplantations were performed during this period. A total of 34 patients (37%) had multiple renal arteries. Mean total ischemia time (single: 55.6 min; multiple: 56 min; p=0.931), anastomosis time (single: 29.6 min; multiple: 29.7 min; p=0.982), bench surgery time (single: 23.5 min; multiple: 23.8 min; p=0.948). Blood transfusion rate was 7% and 14% for group 1 and group 2, respectively (p=0.23). Three patients in group 1 (5.2%) and two patients in group 2 (5.8%) needed dialysis during the first postoperative week (p=1). Overall, recipient complication rate and hospital stay were similar between group 1 and 2. Both groups had a 100% graft survival with a mean follow-up of 35.6 months. Conclusions: The presence of multiple renal arteries should not be considered a contraindication for the living donor nephrectomy, since these grafts achieve similar functional results to single artery renal grafts, without increasing the morbidity of the procedure. (AU)

Post-operative pain after ultrasound transversus abdominis plane block versus trocar site infiltration in laparoscopic nephrectomy: a prospective study / Dor no período pós-operatório de nefrectomia laparoscópica com bloqueio do plano transverso abdominal guiado por ultrassom versus infiltração do sítio do trocarte: um estudo prospectivo

Abstract Background Transversus abdominis plane (TAP) block is useful in reducing post-operative pain in laparoscopic nephrectomy compared to placebo. The purpose of this work is to compare post-operative pain and recovery after TAP block or trocar site infiltration (TSI) in this surgery. Methods A prospective, single blinded study on patients scheduled for laparoscopic nephrectomy. Patients were assigned to two groups: TSI Group: trocar site infiltration at the end of surgery; TAP Group: unilateral ultrasound-guided TAP block after induction. Sevoflurane and remifentanil, in a target controlled infusion mode, were used for maintenance of general anesthesia. Before the end of surgery paracetamol, tramadol and morphine were administered. Visual analogue scale (VAS 0-100 mm) at rest and with cough was applied in three moments: in recovery room (T1 at admission and T2 before discharge) and 24 h after surgery (T3). Pain scores with incentive spirometer were also evaluated at T3. In recovery, morphine was administered as a rescue drug whenever VAS > 30 mm. Time to oral intake, chair sitting, ambulation and length of hospital stay were evaluated 24 h after surgery. Statistical analysis: Student's t-test and Chi-square test, and linear regression models. A p-value < 0.05 was considered significant. Data are presented as mean (SD). Results Forty patients were enrolled in the study. The primary outcome variable, VAS pain scores did not show a statistical significant difference between groups (p > 0.05). VAS at rest (TAP vs. TSI groups) was: T1 = 33 ± 29 vs. 39 ± 32, T2 = 10 ± 9 vs. 17 ± 18 and T3 = 7 ± 12 vs. 10 ± 18. VAS with cough (TAP vs. TSI groups) was: T1 = 51 ± 34 vs. 45 ± 32, T2 = 24 ± 24 vs. 33 ± 23 and T3 = 20 ± 23 vs. 23 ± 23. VAS with incentive spirometer (TAP vs. TSI groups) was: T3 = 21 ± 27 vs. 21 ± 25. Intraoperative remifentanil consumption was similar between TAP (0.16 ± 0.07 mcg.kg-1.min-1) and TSI (0.18 ± 0.9 mcg.kg-1.min-1) groups. There were no differences in opioid consumption between TAP (4.4 ± 3.49 mg) and TSI (6.87 ± 4.83 mg) groups during recovery. Functional recovery parameters were not statistically different between groups. Conclusions Multimodal analgesia with TAP block did not show a significant clinical benefit compared with trocar site infiltration in laparoscopic nephrectomies.

Resumo Justificativa O bloqueio do plano transverso abdominal (TAP) é útil para reduzir a dor no pós-operatório de nefrectomia laparoscópica comparado com o placebo. O objetivo deste estudo foi comparar a dor no pós-operatório e a recuperação após bloqueio TAP ou infiltração do sítio do trocarte (TSI) nesse tipo de cirurgia. Métodos Estudo prospectivo e cego com pacientes agendados para nefrectomia laparoscópica. Os pacientes foram divididos em dois grupos: Grupo TSI: infiltração do sítio do trocarte ao final da cirurgia; Grupo TAP: bloqueio TAP unilateral guiado por ultrassom após a indução. Sevoflurano e remifentanil administrado em perfusão alvo-controlada foram usados para a manutenção da anestesia geral. Paracetamol, tramadol e morfina foram administrados antes do fim da cirurgia. Escala analógica visual (VAS 0-100 mm), para avaliar a dor em repouso e durante a tosse, foi aplicada em três momentos: na sala de recuperação [na admissão (T1) e antes da alta (T2)] e 24 horas após a cirurgia (T3). Os escores de dor com espirômetro de incentivo também foram avaliados em T3. Durante a recuperação, morfina foi administrada como medicamento de resgate, sempre que VAS > 30 mm. Os tempos até a ingestão oral, sentar em cadeira, deambulação e de permanência hospitalar foram avaliados 24 horas após a cirurgia. Análise estatística: teste t de Student, teste do qui-quadrado e modelos de regressão linear. Um valor de p < 0,05 foi considerado significativo. Os dados foram expressos em média (DP). Resultados Quarenta pacientes foram incluídos no estudo. Os escores do desfecho primário e da VAS não apresentaram diferença estatística significativa entre os grupos (p > 0,05). Os escores VAS em repouso (TAP vs. TSI) foram: T1 = 33 ± 29 vs. 39 ± 32; T2 = 10 ± 9 vs. 17 ± 18 e T3 = 7 ± 12 vs. 10 ± 18. Os escores VAS durante a tosse (TAP vs. TSI) foram: T1 = 51 ± 34 vs. 45 ± 32; T2 = 24 ± 24 vs. 33 ± 23 e T3 = 20 ± 23 vs. 23 ± 23. Os escores VAS com espirômetro de incentivo (TAP vs. TSI) foram: T3 = 21 ± 27 vs. 21 ± 25. O consumo de remifentanil no intraoperatório foi semelhante entre os grupos TAP (0,16 ± 0,07 mcg.kg-1.min-1) e TSI (0,18 ± 0,9 mcg.kg-1.min-1). Não houve diferença no consumo de opioides entre os grupos TAP (4,4 ± 3,49 mg) e TSI (6,87 ± 4,83 mg) durante a recuperação. Os parâmetros funcionais de recuperação não foram estatisticamente diferentes entre os grupos. Conclusões A analgesia multimodal com bloqueio TAP não mostrou benefício clínico significativo comparado com a infiltração do sítio do trocarte em nefrectomia laparoscópica.

[Post-operative pain after ultrasound transversus abdominis plane block versus trocar site infiltration in laparoscopic nephrectomy: a prospective study]. / Dor no período pós­operatório de nefrectomia laparoscópica com bloqueio do plano transverso abdominal guiado por ultrassom versus infiltração do sítio do trocarte: um estudo prospectivo.

BACKGROUND: Transversus abdominis plane (TAP) block is useful in reducing post-operative pain in laparoscopic nephrectomy compared to placebo. The purpose of this work is to compare post-operative pain and recovery after TAP block or trocar site infiltration (TSI) in this surgery. METHODS: A prospective, single blinded study on patients scheduled for laparoscopic nephrectomy. Patients were assigned to two groups: TSI Group: trocar site infiltration at the end of surgery; TAP Group: unilateral ultrasound-guided TAP block after induction. Sevoflurane and remifentanil, in a target controlled infusion mode, were used for maintenance of general anesthesia. Before the end of surgery paracetamol, tramadol and morphine were administered. Visual analogue scale (VAS 0-100mm) at rest and with cough was applied in three moments: in recovery room (T1 at admission and T2 before discharge) and 24h after surgery (T3). Pain scores with incentive spirometer were also evaluated at T3. In recovery, morphine was administered as a rescue drug whenever VAS>30mm. Time to oral intake, chair sitting, ambulation and length of hospital stay were evaluated 24h after surgery. STATISTICAL ANALYSIS: Student's t-test and Chi-square test, and linear regression models. A p-value<0.05 was considered significant. Data are presented as mean (SD). RESULTS: Forty patients were enrolled in the study. The primary outcome variable, VAS pain scores did not show a statistical significant difference between groups (p>0.05). VAS at rest (TAP vs. TSI groups) was: T1=33±29 vs. 39±32, T2=10±9 vs. 17±18 and T3=7±12 vs. 10±18. VAS with cough (TAP vs. TSI groups) was: T1=51±34 vs. 45±32, T2=24±24 vs. 33±23 and T3=20±23 vs. 23±23. VAS with incentive spirometer (TAP vs. TSI groups) was: T3=21±27 vs. 21±25. Intraoperative remifentanil consumption was similar between TAP (0.16±0.07mcg.kg-1.min-1) and TSI (0.18±0.9mcg.kg-1.min-1) groups. There were no differences in opioid consumption between TAP (4.4±3.49mg) and TSI (6.87±4.83mg) groups during recovery. Functional recovery parameters were not statistically different between groups. CONCLUSIONS: Multimodal analgesia with TAP block did not show a significant clinical benefit compared with trocar site infiltration in laparoscopic nephrectomies.

Nefrectomía laparoscópica de donante vivo: experiencia de 75 casos consecutivos / Live donor laparoscopic nephrectomy: experience in 75 cases

Background: Live Donor Laparoscopic Nephrectomy (LDLN) has substantial benefits when compared with open nephrectomy such as shorter hospital stay, prompt return to work, less post-operative pain, better cosmetic results, less blood loss and less surgical wound infections. It is the mode of choice for safely harvesting a kidney for organ transplantation. Aim: To describe the surgical results of LDLN in a pioneer renal transplant center in Chile. Material and Methods: Review of clinical records of 75 subjects aged 27 to 60 years (37 males) subjected to a LDLN in a public hospital between 1998 and 2013. Information about clinical and surgical data and perioperative complications was retrieved. Results: No subject died. All kidneys were satisfactorily implanted in their receptors. The mean operative time was 116 minutes. Mean hospital stay was 1.6 days, warm ischemia time was 6.8 minutes, and cold ischemia time was 31.5 minutes. Operative adverse events occurred in 8 percent. The conversion and reoperation rates were 4 and 1.3 percent, respectively. Among receptors, 1.5 percent evolved with Acute Tubular Necrosis and 2.2 percent required graft excision. Conclusions: LDLN is a safe and pioneering surgical technique in Chile. Its results are satisfactory and comparable to those obtained with classic lumbotomy.

Introducción: El trasplante renal es en la actualidad el tratamiento de elección de la Insuficiencia Renal Crónica Terminal. La Nefrectomía Laparoscópica del Donante Vivo (NLDV) tiene ventajas sustanciales en relación a la Nefrectomía Clásica. Entre estas se destacan una menor estancia hospitalaria, pronto regreso a la actividad laboral, disminución del dolor post-operatorio, mejores resultados cosméticos, menor pérdida de volumen sanguíneo y una disminución de infecciones de heridas operatorias, consolidándose como la primera prioridad como forma de obtener un órgano para trasplante renal. El presente trabajo tiene como objetivo mostrar la casuística y complicaciones en el Hospital Barros Luco-Trudeau (HBLT), como centro pionero en NLDV en nuestro país. Material y Método: Estudio retrospectivo de corte transversal. Se realiza una revisión de registros clínicos de 75 NLDV realizadas entre 1998-2013, seleccionando datos demográficos, clínicos y quirúrgicos de donantes y receptores, con un especial énfasis en relación a complicaciones peri-operatorias. Resultados: Sin mortalidad. Todos los riñones fueron implantados satisfactoriamente en sus respectivos receptores. Cirugía con duración promedio de 116 min, estadía hospitalaria promedio de 1,6 días, isquemia caliente promedio de 6,8 min e isquemia fría promedio de 31,5 min. Incidentes operatorios 8 por ciento y 4 por ciento conducentes a conversión. Tasa de reoperación de 1,3 por ciento. En cuanto a receptores, un 1,5 por ciento desarrolla Necrosis Tubular Aguda. 2,2 por ciento requiere transplantectomía. Discusión: La NLDV representa una técnica segura, que ha llegado a constituir el 100 por ciento de las nefrectomías de donantes vivos realizadas durante los últimos tres años. Los resultados son satisfactorios y plenamente comparables a los resultados obtenidos por lumbotomía clásica y de otros centros de alto volumen laparoscópico a nivel internacional.

Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis: are there predictive factors for success?

OBJECTIVES: Laparoscopic nephrectomy for xanthogranulomatous pyelonephritis is currently associated with great operative difficulty and surgical complications. Herein, we report on our single-center experience and describe predictive factors for successfully accomplishing this procedure. METHOD: Between March 1998 and April 2010, 66 patients (27 men and 39 women) underwent laparoscopic nephrectomy for the treatment of a unilateral nonfunctioning kidney. These patients had previous diagnoses of renal chronic inflammation associated with calculi and previous pyonephrosis. All of the nephrectomies were performed using the transperitoneal approach, and a similar technique was used for radical nephrectomy. RESULTS: Laparoscopic nephrectomy for the treatment of renal chronic inflammation was successful in 58/66 cases (87.9%). Eight cases were converted to the open technique because of difficulty in progression, which was related to the discovery of dense adhesions in the hilar or perirenal region. One major (colonic lesion) and two minor (wound infection) complications occurred in the conversion group. A diagnosis of xanthogranulomatous pyelonephritis was confirmed pathologically for all of the specimens. Of the factors examined, a longitudinal renal length greater than 12 cm (laparoscopy group - 7.2±1.8 cm, versus open group - 13.6±1.5 cm; p<0.05) and time to access the renal vessels (laparoscopy group - 32±18 min, versus open group - 91±11 min; p<0.05) were associated with a higher conversion rate. Although the number of patients in the conversion group was small, the majority of these patients received right-sided nephrectomy. CONCLUSIONS: Laparoscopic nephrectomy for the treatment of xanthogranulomatous pyelonephritis is feasible and associated with low levels of morbidity. Factors including the time required to control the renal vessels, renal length and right-sided nephrectomy were associated with higher chances of conversion into an open procedure.

Nefrectomia videolaparoscópica para tratamento da dioctofimose em um cão / Videolaparoscopic nephrectomy in the treatment of canine dioctophymosis

A dioctofimose é uma afecção pouco comum em cães, causada pelo Dioctophyma renale, que ocorre com maior frequência em animais errantes. Quando um único rim é parasitado, os pacientes podem não apresentar sinais clínicos devido à compensação pelo rim contralateral. Não havendo terapia clínica efetiva para a dioctofimose, o tratamento indicado é a nefrotomia ou nefrectomia, na dependência da gravidade da lesão. Foi atendido no Hospital Veterinário da Universidade de Passo Fundo (UPF) um canino, fêmea, castrado, sem raça definida, com aproximadamente um ano e pesando 12 kg, proveniente de um abrigo de animais de rua da cidade de Passo Fundo (RS), apresentando hematúria e emagrecimento progressivo há 30 dias. Através dos exames complementares realizados, foi constatado parasitismo do rim direito por D. renale. O presente relato descreve o emprego alternativo da nefrectomia videolaparoscópica como um método seguro e efetivo para o tratamento de dioctofimose em um cão e os meios utilizados para o diagnóstico.(AU)

Dioctophymosis is a less common disease in dogs caused by Dioctophyma renale, which occurs more frequently in stranded animals. When theres only one kidney affected, there may not be detectable symptoms because theres compensation by the other healthy kidney. Since there is no effective clinical therapy for dioctophymosis, nephrotomy or nephrectomy are the two proposed treatments, depending on the severity of the lesion. A one-year-old spayed female mongrel dog weighing 12 kg was referred to the Veterinary Hospital at the University of Passo Fundo (UPF), brought from an animal shelter at the City of Passo Fundo, RS, Brazil, presenting hematuria and progressive weight loss for about 30 days. Complementary examination showed evidences of parasitism of the right kidney by D. renale. This report describes the alternative use of videolaparoscopic nephrectomy as a safe and effective method in the treatment of dioctophymosis in a dog and the means utilized for diagnosis.(AU)

Nefrectomia videolaparoscópica para tratamento da dioctofimose em um cão / Videolaparoscopic nephrectomy in the treatment of canine dioctophymosis

A dioctofimose é uma afecção pouco comum em cães, causada pelo Dioctophyma renale, que ocorre com maior frequência em animais errantes. Quando um único rim é parasitado, os pacientes podem não apresentar sinais clínicos devido à compensação pelo rim contralateral. Não havendo terapia clínica efetiva para a dioctofimose, o tratamento indicado é a nefrotomia ou nefrectomia, na dependência da gravidade da lesão. Foi atendido no Hospital Veterinário da Universidade de Passo Fundo (UPF) um canino, fêmea, castrado, sem raça definida, com aproximadamente um ano e pesando 12 kg, proveniente de um abrigo de animais de rua da cidade de Passo Fundo (RS), apresentando hematúria e emagrecimento progressivo há 30 dias. Através dos exames complementares realizados, foi constatado parasitismo do rim direito por D. renale. O presente relato descreve o emprego alternativo da nefrectomia videolaparoscópica como um método seguro e efetivo para o tratamento de dioctofimose em um cão e os meios utilizados para o diagnóstico.

Dioctophymosis is a less common disease in dogs caused by Dioctophyma renale, which occurs more frequently in stranded animals. When there’s only one kidney affected, there may not be detectable symptoms because there’s compensation by the other healthy kidney. Since there is no effective clinical therapy for dioctophymosis, nephrotomy or nephrectomy are the two proposed treatments, depending on the severity of the lesion. A one-year-old spayed female mongrel dog weighing 12 kg was referred to the Veterinary Hospital at the University of Passo Fundo (UPF), brought from an animal shelter at the City of Passo Fundo, RS, Brazil, presenting hematuria and progressive weight loss for about 30 days. Complementary examination showed evidences of parasitism of the right kidney by D. renale. This report describes the alternative use of videolaparoscopic nephrectomy as a safe and effective method in the treatment of dioctophymosis in a dog and the means utilized for diagnosis.

Una alternativa de extensión de la vena renal derecha en donante vivo laparoscópico / An alternative for enlargement of right renal vein in laparoscopic living donor nephrectomy

El manejo de la vena renal derecha en la nefrectomía laparoscópica del donante vivo puede en ocasiones representar un problema como consecuencia de la longitud limitada de este vaso. El caso clínico que se presenta muestra una técnica de extensión de la vena renal utilizando la vena gonadal del donante.

Vascular management of the right renal vein during laparoscopic living donor nephrectomy is still an unsolved problem. This short vessel has limited the use of right kidneys. However, the right kidney should be harvested in some instances. A renal vein enlargement technique using the donor gonadal vein is presented which may facilitate the use of right kidneys in this setting.