UROLOGICAL SURVEY
Ramani AP, Ryndin I, Lynch AC, Veetil RT
Section of Laparoscopic Surgery, Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
BJU Int. 2006; 97: 342-4
OBJECTIVES: To review current methods of renal hypothermia during laparoscopic partial nephrectomy.
METHODS: Review paper describing different methods of renal hypothermia during laparoscopic partial nephrectomy, including laparoscopic ice-slush, endoscopic retrograde cold saline infusion, transarterial renal hypothermia, laparoscopic cooling sheath and ancillary techniques for ischemic renoprotection.
CONCLUSION: Renal hypothermia is occasionally required during current laparoscopic renal procedures. Of the various techniques available to achieve laparoscopic renal hypothermia, the surface hypothermia achieved with ice-slush, although cumbersome, duplicates open surgical time-tested principles and is currently the preferred option. Better delivery systems for hypothermic solutions are needed for optimum uniform cooling of the kidney.
Editorial Comment
This paper reviews the different methods of renal hypothermia during laparoscopic partial nephrectomy and succinctly discusses the renal physiology of hypothermia and protective mechanisms from ischemia-reperfusion injury. Not all methods have been established yet. Recent published large series of laparoscopic partial nephrectomy from different institutions have demonstrated that renal functions, as well as, oncological outcomes are comparable to open series without the need of renal hypothermia. Although ablative and reconstructive laparoscopic surgery have been growing and developing fast, fundamental questions remain unanswered; i.e. the optimal method to prevent renal ischemia-reperfusion injury when performing laparoscopic partial nephrectomy.
Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA
Comparison of laparoscopic partial nephrectomy and laparoscopic cryoablation for renal hilar tumors
Hruby G, Reisiger K, Venkatesh R, Yan Y, Landman J
Department of Urology, Columbia University School of Medicine, New York, New York, USA
Urology. 2006; 67: 50-4
OBJECTIVES: To compare laparoscopic partial nephrectomy (LPN) and laparoscopic cryoablation (LC) for the management of small renal tumors located near the renal hilum.
METHODS: A retrospective chart review was performed on all patients who underwent LPN and LC. A total of 23 patients (12 LPN and 11 LC) had tumors located within 5 mm of the renal hilar vasculature. Patient data were retrospectively analyzed for specific parameters, including operative time, efficacy, morbidity, and postoperative course.
RESULTS: All 23 cases were successfully completed laparoscopically. The mean operative time for LPN and LC was 2.8 hours and 2.3 hours, respectively (P = 0.03). The mean estimated blood loss was 197 mL for LPN and 70 mL for LC (P < 0.01). The analgesic requirement for those undergoing LPN and LC was 29 mg morphine equivalent and 23 mg morphine equivalent, respectively (P = 0.41). The hospital stay for patients in the LPN and LC groups was 3.9 days and 3.2 days respectively (P = 0.55). No intraoperative complications occurred in either group. Six patients experienced nine complications in the LPN group. The complications included hemorrhage in 1, fever in 1, ileus in 1, urinary tract infection in 1, urine leak in 4, and transient postoperative neuropathy in 1. The LC group had no postoperative complications. In the LC cohort, no disease recurrence developed during the 11.3 months of follow-up. No positive margins were found in the LPN cohort, and with a mean follow-up of 12 months, none have developed recurrence.
CONCLUSIONS: LPN for hilar tumors is a reasonable surgical option but carries an increased risk of urine leak. LC for hilar tumors has a shorter operative time and results in significantly fewer postoperative complications. Long-term follow-up data for both techniques remain unavailable.
Editorial Comment
Recent data has shown that cryoablation is an emergent effective treatment technology against renal cell cancer. The authors demonstrate the application of such technology in extremely difficult cases (hilar lesions, 5 mm from the renal vessels) without the need of complex reconstructive laparoscopic steps, as in laparoscopic partial nephrectomy. They concluded that laparoscopic cryoablation is a safe procedure that can be applied towards hilar small renal tumors with less complications compared to laparoscopic partial nephrectomy.
Dr. Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA
Endourology & laparoscopy
Publication Dates
-
Publication in this collection
01 June 2006 -
Date of issue
Feb 2006
