Laparoscopy and RoboticHand-Assisted Laparoscopic Nephrectomy for Renal Cell Cancer with Renal Vein Tumor Thrombus
Section snippets
Material and Methods
Histopathology and surgical databases at East Surrey Hospital, Redhill, Surrey, United Kingdom and at Michigan Medical Center, Ann Arbor, Michigan were queried for operations on renal cell carcinoma with tumor thrombus involving the renal vein but not extending into the vena cava (TNM 2002 stage T3b, excluding caval thrombus cases) between 1997 and 2006. Thirteen patients who underwent HALN for nonmetastatic RCC with level 1 tumor thrombus were identified.
Notes and images were reviewed, and
Results
Thirteen patients underwent HALN for T3b disease limited to the renal vein, diagnosed on CT scan. Demographics are shown in Table 1. Perioperative and pathological outcomes are summarized in Table 2.
Five patients (38%) required blood transfusion, including 2 with preoperative anemia and 3 (23%) who experienced major blood loss of more than 1000 mL. One patient was converted to open surgery because of inferior vena cava invasion requiring vascular clamping followed by excision of a segment of
Comment
Tumor thrombus at the level of the renal vein represents a surgical challenge in the laparoscopic era. The accepted treatment has been open surgical nephrectomy with caudal and cephalad control of the vena cava and control of the contralateral renal vein, usually with vascular clamps.10, 11, 12
Several investigators have reported series of laparoscopic operations for tumors with either microscopic13 or macroscopic13, 14, 15, 16, 17 renal vein involvement (summarized in Table 3). Patients have
Conclusions
Hand-assisted laparoscopic nephrectomy provides a safe and effective alternative to open nephrectomy for T3b renal cell carcinoma for which the thrombus is confined to the renal vein; this has allowed us to approach all of the T3b renal tumors referred to us laparoscopically (when thrombus is confined to the renal vein). In common with open surgery and LRN, significant intraoperative bleeding may be encountered when locally advanced tumors are approached with the hand-assisted technique, but in
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Correlation of preoperative imaging characteristics with donor outcomes and operative difficulty in laparoscopic donor nephrectomy
2020, American Journal of TransplantationTreatment of caval vein thrombosis associated with renal tumors
2017, Cirugia EspanolaLaparoscopic management of advanced renal cell carcinoma with renal vein and inferior vena cava thrombus
2014, UrologyCitation Excerpt :With growing experience in laparoscopy, LRN has become the standard of treatment for T1 and T2 RCC with established oncological safety as compared with open surgery. In case of advanced tumors with vascular involvement, multiple case reports and case series have successfully described the role of laparoscopy with encouraging results.9-21 Our retrospective review aimed at documenting the safety and short-term oncologic efficacy of LRN for advanced renal tumors with vascular thrombus.
Is laparoendoscopic single-site surgery a viable approach for radical nephrectomy with renal vein thrombus? Comparison with multiport laparoscopy
2013, UrologyCitation Excerpt :In addition, they reported an overall perioperative complication rate of 14% and transfusion rate of 16% during a mean follow-up of 14 months compared with our overall rates of 23%, 19%, and 21 months, respectively. Henderson et al28 examined outcomes for hand-assisted MPL-RN-RVT (n = 13) and reported a median operative time of 176 minutes, median EBL of 250 mL, median LOS of 3 days, major complication rate of 0%, and transfusion rate of 38% during median follow-up of 32 months. Feasibility of laparoscopic techniques is represented in part by minimal conversion rates to open surgery.
International consultation on urologic diseases and the European association of urology international consultation on locally advanced renal cell carcinoma
2011, European UrologyCitation Excerpt :For thrombus confined to the RV or just entering the IVC (which can be retracted back into the RV), minimal modification to standard approaches to open radical nephrectomy (RN) are required to assure complete removal of the thrombus with negative margins [5]. Several reports of successful minimally invasive approaches to such a low-level thrombus have been published [15–17]. Thrombus above the RV ostium and below the hepatic veins can be managed with occlusion of the vena cava above and below the thrombus as well as occlusion of the contralateral RV.
Comments on article "hand-assisted laparoscopic nephrectomy"
2010, Actas Urologicas Espanolas