Robot-Assisted Partial Nephrectomy for Renal Pelvic Urothelial Carcinoma Complicated with Renal Insufficiency: A Case Report

Background Primary malignant tumors of the renal pelvis are relatively few in urinary tumors, with a high degree of malignancy and a relatively poor prognosis. Most of the pathological results are urothelial carcinoma. The standard surgical operation is full-length resection of the kidney and ureter and sleeve resection of the bladder. However, for patients with renal insufficiency or solitary kidney, clinicians find it terribly difficult to make the decision on the surgical resection and protection of the renal function. A patient with renal pelvis malignant tumor complicated with renal insufficiency was treated in our hospital.Case presentation: A 77-year-old Chinese female with a more than 5-year history of renal dysfunction,was hospitalized due to "painless gross hematuria found for 4 months". The patient had no other significant discomfort. CT discovered that the volume of both kidneys is small, and the soft tissue density shadow was exactly at the right ureteropelvic junction. Therefore we consider the diagnosis was tumor of right renal pelvis. Patient did not accept radical surgical resection and was required to preserve the kidney. So the patient underwent robot-assisted partial nephrectomy for right renal pelvic , and the operation was successful. After surgery chemotherapy drugs were instilled into the renal pelvis through a single J-tube infusion. During nearly three years of follow-up, the patient regularly reviewed ureteroscopy and MRI/CT, no significant abnormalities were seen. Postoperative creatinine control was better and no hemodialysis was performed. The curative effect is acceptable.Conclusions Partial nephrectomy for renal pelvic is also an option for patients with malignant tumor of renal pelvis who need to preserve their kidneys.

Video-assisted thoracic surgery sleeve resection and bronchoplasty using 3D imaging system: its safety and efficacy

Background Video-assisted thoracic surgery sleeve resection with bronchial anastomosis or bronchoplasty is a technically demanding procedure. Three-dimensional endoscopic surgery has been reported to be helpful in decreasing operation time and improving spatial perception with less surgical errors, but there have been rare reports about relatively difficult thoracoscopic procedures utilizing 3D thoracoscope. We performed this study to evaluate early clinical outcomes of thoracoscopic sleeve resection and bronchoplasty utilizing 3D thoracoscope. Methods Data from a total of 36 patients who underwent thoracoscopic sleeve lobectomy or bronchoplasty at our institution from December 2015 to October 2017 were retrospectively reviewed. Three-port approach with one utility incision was used with a 10 mm, 30° three-dimensional thoracoscope. Twenty-three patients (81%) were male, and mean age was 65.9 ± 9.4 years. Fourteen patients (38.9%) underwent sleeve resection with bronchial anastomosis, 22 (61.1%) underwent wedge or simple bronchoplasty, and one patient received concomitant PA procedure. Bronchial anastomosis sites were not covered with viable tissue flaps. Results There was no (0%) suture needle injury from spatial misperception during bronchoplasty or sleeve anastomosis. There was no (0%) operative mortality. The pathologic report revealed squamous cell carcinoma (63.9%), adenocarcinoma (19.4%), carcinoid (6.9%), adenosquamous carcinoma (3.4%), and sarcomatoid carcinoma (2.8%). One (2.8%) late mortality was due to systemic recurrence of sarcomatoid carcinoma. There was no (0.0%) anastomotic failure. The mean number of dissected lymph nodes were 27.4 ± 13.2, and mean operation time was 216.8 ± 60.0 min. Median postoperative 24-h drain amount was 315 mL. Median chest tube days and hospital days were 4 and 6, respectively. Two patients (5.6%) had complications greater than Clavien-Dindo grade II—one case of ARDS, and the other case of a delayed bronchopleural fistula. Conclusions Thoracoscopic sleeve resection and bronchoplasty utilizing HD 3D thoracoscope is a safe and effective procedure with excellent early clinical outcomes. Further investigation for long-term outcomes will be needed.

Therapeutic Strategies for Asymptomatic Upper Urinary Tract Urothelial Carcinoma

A total of 136 patients with upper urinary tract epithelial carcinoma (UTUC) were recruited, of which 21 patients with asymptomatic UTUC were group A, and 115 UTUC patients with hematuria or low back pain were group B. The clinicopathological features, oncologic outcomes, and surgical methods of patients were evaluated. The full-length renal ureterectomy+bladder sleeve resection was the main surgical treatment which was included (group A 80.95%, group B 90.43%). Other patients were treated with kidney-retaining surgery. No statistically significant difference was observed in the grading between groups A and B, pathological stage (p >0.05). During a median follow-up period of 44.3 months, tumor-specific mortality of group A was 7.14%, and that of group B was 5.10%. At the same period, the clinical data of 106 patients with asymptomatic bladder tumor were collected: 31 patients of them had asymptomatic bladder urothelial carcinoma. The asymptomatic UTUC group had a higher stage and grade clinicopathological features (P = 0.00), more aggressive than the asymptomatic bladder urothelial carcinoma group. The principle of asymptomatic UTUC treatment is the same as that of symptomatic UTUC. Risk stratification should be carried out according to clinical staging and other parameters, and the corresponding surgical treatment should be selected.

Salvage endovascular embolization of the left pulmonary artery for recurrent pseudoaneurysm

Background Pulmonary pseudoaneurysm (PPA) is a potentially lethal complication of lung resection with a high risk of recurrence after endovascular coiling. Case presentation We report a case in which recurrent hemoptysis due to PPA after left lower lobe sleeve resection was treated by endovascular embolization of the left main pulmonary artery as a salvage treatment. The first hemoptysis was managed by endovascular coil embolization with extracorporeal membrane oxygenation, but refractory hemorrhage occurred 3 months later due to penetration of the endovascular coil into the bronchial anastomosis site. Because left completion pneumonectomy was considered too high risk, the left main pulmonary artery was palliatively embolized using an Amplatzer vascular plug (St. Jude Medical, MN, USA) to totally disrupt the left pulmonary arterial flow. Conclusions Total embolization of the left main pulmonary artery for repeated PPA rupture may be useful as a palliative treatment in patients unable to tolerate pneumonectomy.

Surgical management of post-transplant bronchial stenoses: a single-center experience

Purpose Bronchial stenoses are challenging complications after lung transplantation and are associated with high rates of morbidity and mortality. We report a series of patients who underwent bronchoplasty or sleeve resection for bronchial stenoses that did not resolve with endoscopic treatment after lung transplantation. Methods Between 1995 and 2020, 497 patients underwent lung transplantation at our Institution. 35 patients (7.0%) experienced bronchial stenoses with a median time from transplantation of 3 months. Endoscopic management was effective in 28 cases (5.6%) while 1 patient required re-transplantation. Six patients (1.2%) underwent bronchoplasty or sleeve resection. Results The procedures of the six patients who underwent bronchoplasty or sleeve resection were as follows: lower sleeve bilobectomy (n = 3), wedge bronchoplasty of the bronchus intermedius (n = 1), isolated sleeve resection of the bronchus intermedius (n = 1), and isolated sleeve resection of the bronchus intermedius (n = 1), associated with a middle lobectomy. All patients were discharged after a median time of 11 days. At a median of 12 months from surgery, two patients remain alive with a preserved pulmonary function. Four patients died after a median time of 56 months from bronchoplasty of causes that were not related to surgery. Conclusions Bronchial reconstructions are challenging procedures that can be performed in highly specialized centers. Despite this, they can be considered a good strategy to obtain a definitive resolution of stenosis after lung transplantation.