A Novel Technique for Hand-Assisted Laparoscopy in Difficult Nephrectomies-Is One Hand Better Than Two? A Single-Centre, Single-Surgeon Series.

Laparoscopic radical nephrectomy is the standard of care for T1 renal tumors and nowadays being used for T2 or higher tumors, resulting in higher the conversion rates. To bridge this gap, the hand-assisted laparoscopy (HAL) method was introduced. Even now, in the robotic era, this HAL approach continues to find importance in urology, especially in the most challenging cases, albeit, with a relatively low usage rate due to the cost involved and availability of hand port devices. Here, we report a case series using a novel modification of the HAL nephrectomy (HALN) technique when open conversion is needed. From a prospective database, we retrospectively analyzed the data of Six patients who underwent HALN at the All India Institute of Medical Sciences between January 2019 and December 2022. Indications for surgery included both malignant and benign renal disease. Four surgeries were performed on the right side while two were performed on the left. Five patients underwent a HALN for renal cell carcinoma (RCC) and 1 for a benign non-functioning kidney. In our series, all the cases with RCC had were T2a or higher. Our case series shows that HALN is technically safe, effective, and a great adjunct to conventional laparoscopy. The ingenious use of a surgical glove as a hand port is an easy-to-make-and- use device in such challenging surgeries.

Invasive micropapillary urothelial carcinoma of the renal pelvis presenting as nonfunctional kidney: A unique presentation and review of the literature.

ABSTRACT: Micropapillary urothelial carcinoma of the renal pelvis is a rare and aggressive variant and poses a diagnostic challenge, especially related to the site and histomorphology of the tumor. A 60-year-old female presented with right pelvic-ureteric junction obstruction and a nonfunctioning right kidney. She underwent a simple right nephrectomy. The microscopy examination revealed a high-grade tumor of the renal pelvis, predominant micropapillary architecture. The tumor infiltrated into the kidney, renal sinus, perinephric fat, adrenal gland, and Gerota's fascia. Extensive lymphovascular and perineural invasions were also noted. On immunohistochemistry, tumor cells were positive for GATA-binding protein 3, cytokeratin 7, and cytokeratin 20, while negative for paired box gene 8, cluster of differentiation 10, mammaglobin, and alpha-methylacyl-CoA racemase. The p63 was positive in the conventional areas and negative in the micropapillary pattern. We reported an additional case of micropapillary urothelial carcinoma of the renal pelvis, literature review, and discussed the differential diagnosis. Immunonegativity of p63 in the micropapillary component was an additional finding.

Bladder Invasion in Patients with Advanced Colorectal Carcinoma.

Involvement of the bladder by colorectal cancer is sufficiently rare to be encountered by an individual surgeon on an infrequent basis. Extirpative procedures for advanced colorectal cancers can involve partial/total bladder resections. In patients without evidence of distant metastatic disease, a reasonable therapeutic effect can be expected when negative surgical margins are obtained. The decision to perform a bladder-sparing procedure or a total pelvic exenteration (TPE) will be based on the extent of the primary lesion as well as patient characteristics. In this study, we report our experience in the management of operable locally advanced colorectal carcinomas involving the urinary bladder. We retrospectively reviewed the hospital records of all patients with advanced colorectal cancer invading the urinary bladder. The age, gender, clinical presentation, physical examination findings, and imaging records were noted. Colonoscopy reports and images were noted and biopsy findings recorded. Similarly, cystoscopy findings and biopsy reports were noted and analyzed. Eight (88%) patients had a primary sigmoid tumor and one (11%) had primary rectal tumor. The clinical staging of the primary tumor was T3 in three (33%) and T4 in six (66%). A biopsy taken during cystoscopy confirmed the malignant lesion in all the nine patients. Four (44%) patients received neoadjuvant chemotherapy with 5-fluorouracil. Eight (88%) patients underwent bladder-sparing resection and the remaining one underwent total pelvic exenteration with ileal conduit for urinary drainage. The mean overall survival was 44 months. The wide spectrum of possible bladder involvement by colorectal cancer requires individual patient-specific and disease-specific approaches. En bloc bladder resection for adherent or invading colorectal cancers achieves good local control and prognosis. The potential for cure in completely excised, node-negative tumors is good. Bladder reconstruction is achievable in most patients.

Nephron Sparing Surgery for Synchronous Bilateral Wilms-Operative Steps.

Approximately 5% of children with Wilms tumor present with bilateral disease. The treatment challenge is to achieve a high cure rate while maintaining adequate long-term renal function. We report the feasibility and outcome of nephron sparing surgery in a child with bilateral Wilms tumor who was treated at our institution.