Is Laparoendoscopic Single-site Surgery a Viable Approach for Radical Nephrectomy With Renal Vein Thrombus? Comparison With Multiport Laparoscopy

Suprapubic-assisted laparoendoscopic single-site surgery versus standard laparoscopic nephrectomy: A propensity score-based analysis

OBJECTIVES

To compare suprapubic-assisted laparoendoscopic single-site surgery nephrectomy with standard laparoscopic nephrectomy.

METHODS

A retrospective case-control study comparing three surgeons' experience with 122 suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and 107 standard laparoscopic nephrectomy was carried out. Operative time, estimated blood loss, intraoperative complications, intraoperative conversion, postoperative bowel recovery, postoperative analgesics, postoperative visual analog pain scale score, postoperative length of stay, days before going back to work, postoperative complications and Patient Scar Assessment Questionnaire were compared after propensity score matching.

RESULTS

A total of 97 matched pairs were obtained after propensity score matching. There were no statistically significant differences between the suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and standard laparoscopic nephrectomy groups with respect to operative time, estimated blood loss, intraoperative complications, intraoperative conversion, postoperative bowel recovery, length of stay and postoperative complications. Suprapubic-assisted laparoendoscopic single-site surgery nephrectomy group had decreased postoperative analgesics (20.9 vs 23.5, P = 0.04), visual analog pain scale score at 24 h (4.28 vs 5.28, P = 0.000), visual analog pain scale score at discharge (1.01 vs 1.47, P = 0.000), days before going back to work (28.4 vs 31.9, P = 0.000) and Patient Scar Assessment Questionnaire score (34.0 vs 42.0, P = 0.000), compared with the standard laparoscopic nephrectomy group.

CONCLUSIONS

Suprapubic-assisted laparoendoscopic single-site surgery nephrectomy and standard laparoscopic nephrectomy are equivalent in terms of the safety and efficacy. However, suprapubic-assisted laparoendoscopic single-site surgery nephrectomy confers less postoperative pain, fewer days before going back to work and better cosmetic result when compared with standard laparoscopic nephrectomy.

Dual Combined Laparoscopic Approach for Renal-Cell Carcinoma with Renal Vein and Level I-II Inferior Vena Cava Thrombus: Our Technique and Initial Results

OBJECTIVE

To present our technique and initial results of dual combined retroperitoneal and transperitoneal laparoscopic approach for the treatment of renal-cell carcinoma (RCC) with level 0-II venous tumor thrombus.

PATIENTS AND METHODS

We included nine consecutive patients with RCC and level 0-II inferior vena cava (IVC) thrombus who underwent laparoscopic radical nephrectomy and IVC thrombectomy using dual combined laparoscopic approach in our department between January 2016 and June 2017.

RESULTS

The mean operative time was 150 minutes when cavotomy was not performed and 240 minutes when cavotomy with thrombectomy was required. The mean IVC clamping time was 24 minutes and the mean blood loss was 300 mL. We encountered no major intraoperative or postoperative complications (Clavien III-IV). The patients were discharged a mean of 7 days after the procedure. At the 6-month follow-up, all patients were alive. One patient presented a retroperitoneal enlarged lymph node and started systemic treatment.

CONCLUSIONS

The dual combined laparoscopic approach for kidney tumors with level 0-II IVC thrombus is feasible, reproducible, and especially useful in patients with complex renal pedicle. The technique provides early arterial control by retroperitoneal approach, which reduces the blood flow through the renal vein and has the advantage of minimal mobilization of the thrombus-bearing renal vein; it therefore lowers the risk of tumor embolism and intraoperative hemorrhage.

Endovascular Renal Artery Stent Retriever Embolectomy in a Young Patient With Cardiac Myxoma: Case Report and Review of the Literature

Purpose:

Cardiac myxomas are common tumors of the heart with disproportionate impact on young patients, occasionally with dramatic systemic dissemination of tumor emboli with catastrophic multiorgan system ischemia. The coincident comorbidities can increase the risk of traditional treatments for tumor embolus in each region.

Case report:

A young patient with previously unknown cardiac myxoma presented with seizure and was found to have stress cardiomyopathy, multiple cerebral large vessel occlusions with acute ischemic stroke, bilateral lower extremity tumor emboli and rhabdomyolysis, and renal tumor embolus with acute tubular necrosis. We describe a multidisciplinary approach applying cerebrovascular stent retriever devices in tumor embolectomy of the renal artery of a young patient with systemic morbidity, preventing safe laparotomy for open surgical tumor embolectomy.

Conclusion:

We describe 2-month renal function outcomes and the considerations in applying a neuroendovascular mechanical thrombectomy device within the renal artery. This was a radiographically successful technique and her renal function appears to be improving at the 2-month follow-up, although this is complicated by other renal insults and support.

Oncologic and Functional Outcomes of Laparoendoscopic Single-Site Radical Nephrectomy for Localized Kidney Cancer: A Single Surgeon's Series with a Minimum of 3-Year Follow-Up

OBJECTIVE

To evaluate intermediate-term oncologic and renal functional outcome of laparoendoscopic single-site radical nephrectomy (LESS-RN) in the treatment of localized kidney cancer.

METHODS

We performed a chart review of patients who underwent LESS-RN between 2009 and 2011 at our institution. Patients with a minimum of 3 years of follow-up were included in this study. The demographic data and main perioperative outcome variables were analyzed. Estimated glomerular filtration rate was calculated using the Modification of Diet Renal Disease equation. Upstaging of chronic kidney disease (CKD) was calculated. The Kaplan-Meier method was used to calculate overall survival (OS), cancer-specific survival (CSS), and cancer-free survival (CFS). Multivariate logistic regression was performed to show predicting factors for an undesirable outcome arbitrarily defined as any one or more of the following events: surgical conversion, complication of Clavien grade >2, new onset of CKD stages ≥3 at the latest follow-up, or cancer recurrence or metastasis.

RESULTS

A total of 51 patients were included with a median follow-up of 41 (interquartile range: 38-45) months. The OS, CSS, and CFS rates at 3 years were 100%, 100%, and 98%, respectively. There was a 74.5% (38/51) upstaging of CKD at the latest follow-up, with 22 patients (43.1%) who developed a new onset of CKD stages ≥3. Multivariate analysis showed that patient age, body mass index, Charlson comorbidity index, early surgeon experience, and follow-up duration (all p < 0.05) have increased the odds of an undesirable outcome.

CONCLUSIONS

For localized kidney cancer, LESS-RN is effective in oncologic control at an intermediate follow-up interval but, similar to other kinds of RN technique, it is associated with worsened renal functional outcomes.