Application of Ultrasound-guided Intercostal Nerve Block in Retroperitoneal Laparoscopic Nephrectomy

Purpose: Surgical stimulation causes many pathophysiological changes which are not conducive to the recovery of patients, this trail aims to investigate whether intercostal nerve block can reduce the perioperative stress response and postoperative pain in patients undergoing elective retroperitoneal laparoscopic nephrectomy.Patients and methods:40 patients were recruited and randomly assigned to Test groupand Blank group.Results: Our study found that the catecholamine and cortisol levels in two groups were higher than the baseline value after pneumoperitoneum, (P＜0.05), while the catecholamine level was lower in Test groupthan in Blank group (P＜0.05), and there is no differences of cortisol levels was observed in two groups. The catecholamines and cortisol levels of two groups were basically restored to the preoperative level after 24 hours surgery, The concentration of IL-6 and IL-10 in two groups increased at 24 hours after surgery, but there was no differences was observed between the two groups at the same point. And the usage of analgesic during operation was less in the Test group than Blank group (P＜0.05).Conclusion : Intercostal nerve block can reduce the stress response of patients undergoing retroperitoneal laparoscopic nephrectomy and reduce the usage of perioperative analgesics.Tial registration statement : This trial has been applied by the ethics Association of Chongqing cancer hospital.

Polymer Ligating Clips in Urologic Laparoscopic Surgery

Introducing polymer ligating clips (PLC) or Hem-o-lok clips was a useful alternative to titanium clips in order to perform a safe, efficient and rapid ligation of the vascular structures during laparoscopic and/or conventional surgical procedures. In urologic surgery they are useful during ablative laparoscopic surgery for renal tumor, urothelial tumors, non-functional kidney, bladder tumors and prostate tumors. Polymers� properties depend on the structure of molecules and vary from flexible substances to expandable rigid materials. They have a high resistance to shock, considerable abrasion resistance and precise durability. Polymers can easily take the desired shape, due to different processing modes. They also have the property of resistance to sustainable action of external forces. The aim of this paper is to evaluate the efficacy and safety of PLC used during renal pedicle ligation in retroperitoneal laparoscopic nephrectomy for renal tumors, high urothelial tumors and nonfunctional kidney.

Open surgery versus retroperitoneal laparoscopic nephrectomy for renal tuberculosis: a retrospective study of 120 patients

Background Laparoscopic renal surgery has been widely used in the treatment of renal diseases. However, there is still little research about its application in addressing renal tuberculosis. The purpose of this study is to retrospectively investigate the surgical results of laparoscopic and open surgery for nonfunctional tuberculous kidneys. Methods Between May 2011 and June 2016, 120 nephrectomies were performed in patients with a nonfunctional tuberculous kidney. Of these, 69 patients underwent retroperitoneal laparoscopic nephrectomy, and 51 patients underwent open nephrectomy. Data about the patients’ characteristics and surgical outcomes were collected from their electronic medical records. Outcomes were compared between these two groups. Results Our results showed that a number of renal tuberculosis patients presented no significant symptoms during their disease. Lower urinary tract symptoms (LUTS) were the most common at a rate of 73/120, followed by flank pain or accidently discovery (66/120), urine abnormality (30/120) and fever (27/120). Patients who underwent open surgery were similar to laparoscopic patients with regard to sex, BMI, location, previous tuberculous history, grade, anemia, adhesion, hypertension, diabetes and preoperative serum creatinine level, but were generally older than laparoscopic patients. There were no significant differences between open and laparoscopic surgery in estimated blood loss, transfusion, postoperative hospital days and perioperative complication rate. However, the median operation time of laparoscopic operation was much longer than open surgery (180 [150–225] vs 135 [120–165] minutes, P < 0.01). Seven of the 69 laparoscopic operations were converted to open surgery because of severe adhesions. Conclusion Laparoscopic nephrectomy is as an effective treatment as open surgery for a nonfunctional tuberculous kidney, although it requires more time during the surgical procedure. No significant differences in other surgical outcomes were observed.