scholarly journals INITIAL EXPERIENCE OF LAPAROSCOPIC PARTIAL NEPHRECTOMY IN HASAN SADIKIN GENERAL HOSPITAL BANDUNG

2016 ◽  
Vol 23 (1) ◽  
Author(s):  
Nanda Daniswara ◽  
Sawkar Vijay Pramod ◽  
Jupiter Sibarani ◽  
Ferry Safriadi

Objective: To describe our experience about laparoscopic partial nephrectomy to treat localized renal tumour patients in Urology Department Hasan Sadikin General Hospital Bandung. Material & method: In 2014, there were 6 female patients that underwent laparoscopic partial nephrectomy in Hasan Sadikin General Hospital Bandung. In one case, there were tumours on both kidneys. Five patients were underwent transperitoneal approach and 1 patient were undergo retroperitoneal approach. All patients were examined with ultrasonography and Abdominal CT scan with contrast. We also calculate RENAL nephrometry score. Results: There were 6 female patients with left flank pain that undergo laparoscopic partial nephrectomy. In one case, there are tumours on both kidneys. In RENAL nephrometry score calculation, there were 3 patients with 10x score, 1 patient with 11x score, 1 patient with 7x score, and 1 patient with 6p score. From all of them, 4 patients were successfully performed laparoscopic partial nephrectomy, 1 patients was undergo laparoscopic nephrectomyand 1 patient is converted to open partial nephrectomy. Five patients were undergo transperitoneal approach and 1 patient was undergo retroperitoneal approach. Surgery ranged from 180-240 minutes. Intra operative bleeding was ranged from 50-200 cc. Tramadol intravenous was used for post operative pain control. With VAS score in first post operative day was 6, and 2 at the time of discharge. Hospitalized time was ranged from 4-6 days. Conclusion: Laparoscopic partial nephrectomy is an alternative treatment that safe for localized renal tumour. This procedure is depend on the technique and approach from each Urologist. Our limitations are we didn’t have laparoscopic ultrasonography and the tumour close to pelvocalyces system.

2014 ◽  
Vol 8 (3-4) ◽  
pp. 137
Author(s):  
Dong Soo Park ◽  
Jin Ho Hwang ◽  
Moon Hyung Kang ◽  
Jong Jin Oh

Introduction: We investigate the clinical significance of the R.E.N.A.L. nephrometry score for renal neoplasm following open partial nephrectomy (PN) under cold ischemia.Methods: A retrospective analysis was conducted using clinical data of 98 consecutive patients with clear cell renal cell carcinoma who underwent open PN by a single surgeon from December 2000 to September 2012. Tumour complexity was stratified into 3 categories: low (4-6), moderate (7-9) and high (10-12) complexity. Perioperative outcomes, such as complications, cold ischemic time, estimated blood loss and renal function, were analyzed according to the complexity by NS. Complications were stratified using the Clavien-Dindo classification system.Results: Tumour complexity according to nephrometry score was assessed as low in 16 (16.3%), moderate in 48 (49.0%) and high in 34 (34.7%). The median cold ischemic time did not differ significantly among the 3 groups (36.0 minutes in low-, 40 minutes in moderate- and 43 minutes in the high-complexity group, p = 0.421). Total complications did not differ significantly (2 (2.0%) in low, 4 (4.1%) in moderate and 4 (4.1%) in high, p = 0.984). Each Grade 3 complication occurred in the moderate (urine leakage) and high groups (lymphocele). Postoperative renal functional outcomes were similar among the groups (p = 0.729). Only mean estimated blood loss was significantly different with nephrometry score (p = 0.049).Conclusions: The nephrometry score, as used in an open PN series under cold ischemia, was not significantly associated with perioperative outcomes (i.e., ischemia time, complications, renal functional preservation).


Author(s):  
Emanuele Corongiu ◽  
Pietro Grande ◽  
Angelo Di Santo ◽  
Giorgio Pagliarella ◽  
Stefano Squillacciotti ◽  
...  

Objectives: To evaluate oncological feasibility and oncological and functional results of retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy (LPN). Patients and methods: Patients with posterior renal masses with low nephrometry score (RENAL ≤ 7) treated who underwent retroperitoneal sutureless zero ischemia.in a single center from January 2016 to November 2017. Clinical, surgical and pathological data were prospectively collected. Complications were reported according to the modified Clavien classification. Results: Retroperitoneal sutureless zero ischemia laparoscopic partial nephrectomy was performed on 15 patients. The indication for nephron-sparing surgery was elective in 11 (73%) patients and imperative in 4 (27%). Median RENAL score was 5 (IQR: 5-7), median tumor diameter 25 mm (IQR: 20-35). In 11 cases, the tumor was located polar (85%), and in 2 cases hilar (15%). There were no intraoperative complications. No cases were converted to radical nephrectomy, and in no case parenchyma suture was necessary. Median operative time was 90 min (IQR:40-150), in no case clamping of the renal artery was necessary, median hospital stay was 4 days, median estimated blood loss (EBL) was 310 (180-500) ml. Pathological analysis showed renal cell carcinoma in 11 patients (85%), 9 (60%) staged T1a and 2 (13%) T1b. In 4 (27%) an oncocytoma was found. There were no positive surgical margins. One patient developed a major postoperative complication (postoperative renal bleeding requiring super-selective embolization). Trifecta rate was 93%. Conclusions: Sutureless retroperitoneal zero ischemia LPN for the treatment of low-complexity posterior renal masses showed to be safe and feasible. Longer follow-up and higher numbers of patients are, however, warranted to draw definitive conclusions on functional outcomes.


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