Retroperitoneal laparoscopic nephrectomy for kidney tuberculosis

Objective To discuss the feasibility and safety of retroperitoneal laparoscopic nephrectomy for treatment of kidney tuberculosis. Methods From March 2005 to February 2009,28 patients with kidney tuberculosis underwent retroperitoneal laparoscopic nephrectomy. The patients’ data were reviewed and analyzed. Results

Clinical Nursing for Patients Undergoing Prone-Position Laparoscopic Partial Nephrectomy

Objective:To explore effective nursing strategies for patients undergoing prone-position laparoscopic partial nephrectomy.Methods:A total of 19 patients undergoing prone-position laparoscopic partial nephrectomy were selected,with hospital admission spanning from January 2024 to June 2024.Patients were randomly divided into the study group(n=10)and the control group(n=9).The control group received basic nursing care,while the study group received comprehensive high-quality nursing care.The recovery period,length of hospital stay,complication rates,SCL-90 scores,and nursing quality scores were compared between the two groups.Results:The recovery period and hospital stay were significantly shorter in the study group compared to the control group(P<0.05).The complication rate in the study group was lower than that in the control group(P<0.05).After the nursing intervention,the SCL-90 scores of the study group were lower than those of the control group(P<0.05).Nursing quality scores were higher in the study group than in the control group(P<0.05).Conclusion:Comprehensive high-quality nursing intervention for patients undergoing prone-position laparoscopic partial nephrectomy can shorten the recovery period and hospital stay,reduce the complication rate,improve mental health,and enhance nursing quality,making it suitable for wider application in medical institutions.

Surgical Video Review of Warm Ischemia Time during Laparoscopic Partial Nephrectomy and Impact on Positive Surgical Margins and Postoperative Complications

Introduction: A surgical video review is an emerging tool for quality improvement, especially in complex surgeries such as laparoscopic partial nephrectomy (LPN). Assessing and measuring the warm ischemia time (WIT) during LPN by dividing it into the time used for resection (ResT), time used for reconstruction (RecT) and intermediate time (IntT) has not been performed before. This study aimed to analyze the factors that can influence all these surgical times and assess their impact on positive surgical margins (PSM) and complication rates. Methods: We evaluated 36 surgical video recordings from patients who underwent LPN and measured WIT, ResT, RecT and IntT with a stopwatch. Factors such as tumor characteristics and surgeon experience were also recorded. SPSS software was used to identify the predictor factors for all these surgical times and to correlate the ResT with PSM and RecT with the complication rate. Results: We recorded a mean WIT of 887 seconds. The mean ResT, RecT and IntT were 240 (27.2% of WIT), 473 (52.6% of WIT) and 173 s (20.2% of WIT), respectively. We found a moderate correlation between the WIT (p = 0.030), IntT and the R.E.N.A.L. score (p = 0.019). The surgeon with less than 100 LPN had significantly longer WIT, ResT, and RecT values, with means of 977 (p = 0.015), 268 (p = 0.019) and 530 seconds (p = 0.015), respectively. No correlation was found between ResT and PSM (p = 0.418);however, a strong correlation was found between RecT and the probability of developing complications (p = 0.012). Conclusion: The surgeon’s experience influences WIT, ResT, and RecT, but not IntT, which depends on tumor complexity. RecT affects the probability of developing complications. IntT represents a fifth of the WIT and efforts to reduce the WIT should focus on reducing the IntT for complex tumors, by improving surgical planning.

Successful resuscitation after fatal carbon dioxide embolism during laparoscopic nephrectomy

Laparoscopic nephrectomy （LN） is a less invasive surgical option for patients with renal disease.However,it may be complicated with disastrous CO2 embolism,which is rare but a life-threatening consequence.Here,we present a case of lethal CO2 embolism during LN.Fortunately,the complication was detected early and managed successfully.Our case and literature review all revealed that gas embolism must be considered as a possible cause of sudden cardiocirculatory failure during LN;rapid diagnosis and definitive intervention can decrease fatality from such an injury.Possible mechanisms of CO2 embolism and the potential ways of handling such an event are also discussed.Keywords：laparoscopic nephrectomy; gas embolism; transesophageal echocardiography

Laparoscopic vs open donor nephrectomy:Lessons learnt from single academic center experience

AIM To compare laparoscopic and open living donor neph-rectomy, based on the results from a single center during a decade.METHODS This is a retrospective review of all living donor neph-rectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy （LLDN） and 211 undergoing open donor nephrectomy （OLDN）. Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular fltration rate and creatinine （Cr）, donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed.RESULTSOverall there was no statistically significant differencebetween the LLDN and the OLDN groups regardingoperating time, donor preoperative renal function, donorand recipient postoperative kidney function, delayed graftfunction or the incidence of major complications. Whenthe last 100 laparoscopic cases were analyzed, there wasa statistically significant difference regarding operatingtime in favor of the LLDN, pointing out the importanceof the learning curve. Furthermore, another significantdifference between the two groups was the decreasedlength of stay for the LLDN （2.87 d for LLDN vs 3.6 d for OLDN）.CONCLUSION Recognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profle comparable to OLDN and decreased length of stay for the donor.

Pneumothorax during retroperitoneal laparoscopic partial nephrectomy in a lupus nephritis patient:A case report

BACKGROUND Downgrading target treatment and laparoscopic partial nephrectomy have become increasingly popular in patients with renal cell carcinomas.Rare as it is,pneumothorax is one of the most severe intraoperative complications which needs immediate recognition.On the other hand,as a rheumatological disease,lupus nephritis requires a long period of hormone therapy.Cases of pneumothorax in hormone-consuming renal cancer patients are even fewer.CASE SUMMARY A 39-year-old woman was admitted to our department to take a laparoscopic partial nephrectomy.The patient had a medical history of lupus nephritis and renal clear cell carcinoma with hormone and target treatment.Her blood oxygen saturation dropped to 92%during the operation,and pneumothorax was detected by ultrasound.O2 inhalation and lung dilation were performed.Her vital signs were monitored closely throughout the operation.The operation was accomplished,and she regained consciousness smoothly.A postoperative bedside chest X-ray was conducted after she was transferred to the urosurgery ward,while no evidence of further pneumothorax or lib injury was observed.CONCLUSION Pneumothorax is a severe complication in laparoscopic or robotic-assisted laparoscopic operations,especially in retroperitoneal ones.It is easily neglected unless the injury of the diaphragm is found.Low insufflation pressure and shorter operation time are necessary for patients with a history of long-term hormone consumption or chronic immune system disease.

Prediction of Intraoperative Trifecta Achievement during Laparoscopic Partial Nephrectomy

Purpose: We introduce the concept of intraoperative Trifecta during laparoscopic partial nephrectomy (LPN) as the simultaneous achievement of estimated blood loss (EBL) < 500 ml, warm ischemia time (WIT) < 20 minutes and minimal changes of the intraoperative course. The study’s aim was to find preoperative factors that could predict the likelihood of achieving intraoperative Trifecta and build a surgical nomogram. Methods: We retrospectively evaluated 122 patients who underwent LPN. Preoperative factors like age, sex, body-mass index (BMI), kidney function, tumor characteristics (R.E.N.A.L. score) and Charlson-Comorbidity-Index (CCI) were recorded. Intraoperative complication (IOC) was graded according to the Rosenthal classification. R software was used to find a predicting model for achievement of Trifecta using preoperative variables and a nomogram was built. Results: The surgical features include median EBL of 100 ml having 6.5% bleed > 500 ml, median WIT of 12 minutes having 7.3% more than 20 minutes. There was recorded a 12.3% IOC with a mean Rosenthal’s grade of 0.2. Intraoperative Trifecta was achieved in 105 patients (86%) and three preoperative factors were chosen for the predictive model: BMI (p = 0.041), CCI (p = 0.037) and RENAL score (p = 0.002). A nomogram was generated and the ROC-AUC of the model was 75.8%. Conclusion: We have defined an intraoperative Trifecta concept as the achievement of EBL < 500 ml, WIT < 20 minutes and minimal changes of the intraoperative course. A nomogram was developed from preoperative factors like BMI, CCI and R.E.N.A.L. score. It can be used to estimate the probability of Trifecta achievement in patients treated with LPN.

Harmonic scalpel versus traditional scissors in laparoscopic partial nephrectomy:A propensity score-based analysis

Objective:The present study aims to compare the clinical efficacy of laparoscopic partial nephrectomy using a harmonic scalpel versus traditional scissor.Methods:A retrospective review was conducted in patients with localized renal tumors and scheduled for laparoscopic partial nephrectomy from January 2015 to December 2019.Eventually,225 patients joined this retrospective study.Patients were divided into the harmonic scalpel group or scissor group based on the method used,with 71 cases and 154 cases respectively.Propensity score matching(1:1)was performed to adjust for potential baseline confounders,and each group had 57 cases.Patient characteristics,perioperative clinical results,complications,and oncological results were compared between the two groups.Results:After matching,patient characteristics were not significantly different between the two groups.The scissor group was associated with a significantly shorter operative time(105 min vs.130 min,p<0.001),shorter warm ischemia time(19.35 min vs.22.07 min,p?0.005).However,the harmonic scalpel group was associated with significantly less estimated blood loss(20 mL vs.30 mL,p?0.013)and shorter length of stay(8 d vs.10 d,p?0.040).There was no significantly difference in indwelling time of drainage tube,perioperative complication,oncological outcomes or recurrence rates.Conclusions:The harmonic scalpel is used safely and effectively in laparoscopic partial nephrectomy,and has benefits in intraoperative blood loss and length of stay.

Current practice of live donor nephrectomy in Turkey

BACKGROUND Over the last few years,the deceased donor organ donation rate was declined or remained stable,whereas the live donor organ donation rate has increased to compensate for the demand.Minimally invasive techniques for live donor nephrectomy(LDN)have also improved the live donor kidney donation rates.This increase has led to an interest in the surgical procedures used for LDN.AIM To evaluate the LDN techniques performed in Turkey,the structure of surgical teams,and the training received.Additionally,the number of kidney transplantations at different centers,the surgeon experience level,differences in surgical approach during donor surgeries,and outcomes were assessed.METHODS A questionnaire was sent to the Turkish Ministry of Health-accredited transplant centers.It inquired of the number of LDN surgeries,surgical techniques,complications,optimization protocols,the experience of surgeons,and the training.Descriptive statistics were outlined as follows:Discrete numeric variables were expressed as medians(minimum-maximum),while categorical variables were shown as numbers and percentages.As a result of the goodness-of-fit tests,if the significance of the differences between the groups in discrete numerical variables for which the parametric test statistical assumptions were not met,data were analyzed with the Mann Whitney U test and theχ^(2)test.RESULTS The questionnaire was sent to 72 transplant centers,all of which replied.Five centers that reported not performing LDN procedures were excluded.Responses from the remaining 67 centers were analyzed.In 2019,the median number of kidney transplants performed was 45,and the median number of kidney transplants from living donors was 28(1-238).Eleven(16.5%)centers performed 5-10,while 34(50.7%)centers performed more than 100 live donor kidney transplants in 2019.While 19(28.4%)centers performed the LDN procedures using the open technique,48(71.6%)centers implemented minimally invasive techniques.Among the centers preferring minimally invasive techniques for LDN,eight(16.6%)used more than one surgical technique.The most and the least common surgical techniques were transperitoneal laparoscopic(43 centers,89.6%)and single port laparoscopic LDN(1 center,2.1%)techniques,respectively.A positive association was found between the performance of minimally invasive techniques and the case volume of a transplant center,both in the total number and live donor kidney transplants(15 vs 55,P=0.001 and 9 vs 42,P≤0001 respectively).The most frequently reported complication was postoperative atelectasis(n=33,49.2%).There was no difference between the techniques concerning complications except for the chyle leak.CONCLUSION Turkish transplant centers performed LDN surgeries successfully through various techniques.Centers implementing minimally invasive techniques had a relatively higher number of live donor kidney transplants in 2019.

Comparison of two different renorrhaphy techniques in retroperitoneal laparoscopic partial nephrectomy for complex tumor

Background Partial nephrectomy is currently the standard treatment for clinical T1 renal neoplasms, as it can provide oncologic outcomes equivalent to radical nephrectomy. The aim was to evaluate the efficacy of self-retaining suture （SRS） in renorrhaphy technique in retroperitoneal laparoscopic partial nephrectomy （LPN） for a single renal mass of moderate or high complexity by assessing peri-operative outcomes. Methods A retrospective analysis was done of 64 patients between 2010 and 2012 for complex renal mass （RENAL score 〉7） in whom retroperitoneal LPN was performed with two layers using continuous knotless barbed suture （Quill PDO SRS group; n=34） and absorbable vicryl （non-SRS group; n=30）, respectively. Cases were matched for RENAL score. All the surgical procedures were performed by the same surgeon with experience of more than 500 cases of LPN. Comparisons were made in patients and preoperative outcomes and peri-operative complications between SRS group and non-SRS group. Results Mean warm ischemia time （WIT） in SRS group was less than non-SRS group （18.0 vs. 24.8 minutes, P=-0.021）. Renorrhaphy suture cost in SRS group was lower than non-SRS group （$269.6 vs. $335.8, P=0,001）. There were no significant differences between the two groups for postoperative changes in creatinine and estimated glomerular filtration rate and the rate of peri-operative complications. Conclusion SRS was safe for complex renal tumor with two layers, continuous and unknot suture, during LPN and would reduce the WIT and renorrhaphy suture cost significantly.

Long-term oncologic outcomes of laparoscopic versus open partial nephrectomy

Background Most of the literatures on laparoscopic partial nephrectomy （LPN） versus open partial nephrectomy （OPN） focus on technical details and early or mid-term oncologic outcomes, reflecting that the approach is safe and provides mid- term benefits compared with traditional open surgery. However, the difference of long-term oncologic outcome between LPN and OPN remains unclear. The aim of this meta-analysis was to evaluate the long-term oncologic outcome of LPN in the treatment of localized renal tumors compared with that of OPN. Methods A systematic search of electronic databases including Medline, Embase, and Cochrane library was conducted. Comparative studies reporting on long-term oncologic outcome of LPN versus OPN were regarded eligible. The odds ratio （OR） and its corresponding 95% confidence intervals （CO were calculated for the oncologic outcomes. The methodologic quality of the included studies was evaluated using the strict criteria of the Newcastle-Ottawa scale. Results Six comparative studies （1495 participants including 555 LPN and 940 OPN） were included in the present study. There was no significant difference between LPN and OPN in 5-year overall survival （OS） rates （OR=1.83, 95% Cl （0.80, 4.19））, 5-year cancer specific survival （CSS） rates （OR=1.09, 95% CI （0.62, 1.92））, and 5-year recurrence free survival （RFS） rates （OR=0.68, 95% CI （0.37, 1.26））. Conclusion The results of this meta-analysis revealed that there was no significant difference in long-term oncologic outcome between LPN and OPN for treatment of localized renal tumors.

Synchronous sporadic bilateral multiple chromophobe renal cell carcinoma accompanied by a clear cell carcinoma and a cyst: A case report

BACKGROUND Renal cell carcinomas are usually unilateral.However,they are bilateral in 2%to 4%of sporadic cases and is considerably more common in familial cases.Synchronous sporadic bilateral multiple chromophobe renal cell carcinoma(CHRCC)with different subtypes is rare.CASE SUMMARY In this case report,we describe a case of synchronous bilateral CHRCC with two histological variants,accompanied by a clear cell carcinoma and a cyst in a 50-year-old male.The patient underwent retroperitoneal laparoscopic bilateral nephron-sparing surgery and there was no serious postoperative renal dysfunction.CONCLUSION We report a rare case of synchronous bilateral CHRCC with two histological variants associated with a clear cell carcinoma and a cyst.

The Effect of Different Surgical Methods on the Number of Circulating Tumor Cells in the Peripheral Blood of Patients with Renal Cell Carcinoma

Objective: The objective is to explore the effects of different surgical methods-retroperitoneal laparoscopic radical nephrectomy (RLRN) and open radical nephrectomy (ORN) on the number of circulating tumor cells (CTC) in the peripheral blood of patients with renal cancer. Methods: The clinical data of 63 patients in the Department of Urology, Affiliated Hospital of Chengde Medical College who underwent radical surgery for renal cancer were divided into CTC positive group (18 cases of open surgery and 16 cases of minimally invasive surgery) and CTC negative group (14 cases of open surgery), 15 cases of minimally invasive surgery), overall group (32 cases of open surgery, 31 cases of minimally invasive surgery). Observe the changes in the number of CTC 1 week before operation and 1 week after operation. Results: In the positive group, whether it was open surgery or minimally invasive surgery, the postoperative CTC level of patients was significantly reduced (P < 0.05). In the negative group, the CTC decreased significantly after open surgery (P > 0.05), and the CTC level decreased significantly after minimally invasive surgery (P < 0.01). In the overall group, both open and minimally invasive surgery CTC decreased significantly, and the difference was statistically significant (P < 0.05). Conclusion: The two different surgical methods can reduce the level of CTC, but compared with ORN, RLRN can significantly reduce the number of postoperative CTC. Patients in the CTC-negative group may be less suitable for open surgery. CTC levels have certain potential in the selection and guidance of treatment modes for patients with renal cell carcinoma (RCC).