Recently, nephron-sparing, minimally invasive surgery of small renal masses has become popular. The most typical surgery is laparoscopic partial nephrectomy (LPN). However, due to technical difficulties, the indications for LPN had been limited to small, exophytic, and peripheral tumors. This paper introduces current status of oncological outcomes and technical considerations.
Kidney ; Laparoscopy ; Nephrectomy*

Laparoscopic partial nephrectomy has been recently applied as a minimally invasive procedure. Several non-ischemic operation devices for partial nephrectomy have been developed. Two patients with small renal tumors successfully underwent laparoscopic partial nephrectomy at our institution with using a microwave tissue coagulator without any immediate complication. The renal parencyme around the tumor was coagulated using a microwave tissue coagulator with a probe 1.5cm in length. The tumor was circumscribed within the coagulated area, and partial nephrectomy was performed using scissors. Laparoscopic non-ischemic partial nephrectomy using a microwave tissue coagulator may be feasible for treating selected small renal tumors.
Humans ; Kidney ; Laparoscopy ; Microwaves* ; Nephrectomy*

PURPOSE: To evaluate the relationship between RENAL nephrometry score (RNS) and operative approach for renal masses. MATERIALS AND METHODS: This study included 206 consecutive patients who underwent renal tumor surgery between January 2008 and October 2012. We divided the patients into four groups by surgical approach: open radical nephrectomy (ORN, 53 patients), laparoscopic radical nephrectomy (LRN, 83 patients), open partial nephrectomy (OPN, 31 patients), and laparoscopic partial nephrectomy (LPN, 39 patients). We retrospectively assessed the RNS for each surgery group and evaluated the relationship between this score and operative approach. RESULTS: The mean RNSs of the ORN, LRN, OPN, and LPN groups were 9.75, 8.35, 6.72, and 5.76, respectively. When the RNS was analyzed according to nephron-sparing, the mean RNSs of the RN groups (ORN and LRN) and the PN groups (OPN and LPN) were significantly different (8.89 and 6.09, respectively; p<0.001). All the individual components of the RNS were significantly different between RN and PN. In the RN groups, the criteria for open versus laparoscopic surgery were based on tumor size ('R' score=2.43 for open, 1.54 for laparoscopic, p<0.001) and tumor location relative to the polar line ('L' score=2.55 for open, 2.09 for laparoscopic, p=0.006). In the PN groups, the criteria for open or laparoscopic surgery were based only on exophytic/endophytic property ('E' score=1.87 for open, 1.41 for laparoscopic, p=0.046). CONCLUSIONS: The RNS was significantly different in all surgery groups. The decision to take a laparoscopic approach was primarily influenced by the R and L scores for RN and by the E score for PN.
Humans ; Kidney ; Laparoscopy ; Nephrectomy ; Retrospective Studies

Pediatric laparoscopic nephrectomy is a safe procedure and can be managed best if we forsee possible complications that are intrinsic with the procedure. Pediatric patients present a intricate challenge to the anesthesiologist. The anatomical peculiarities in them create dilemma in airway management, notwithstanding the cardiovascular and pulmonary complications that should be anticipated with laparoscopy. A meticulous preoperative evaluation will help us to identify probable difficulties in management of anesthesia. General endotracheal anesthesia that is circumspectly planned and smoothly carried out is the anesthetic technique of choice for our patients. Sevoflurane proves to be the ideal volatile anesthetic for laparoscopic surgery in pediatrics. Use of muscle relaxant is a must and should be guided by the use of a peripheral nerve stimulator. The collective efforts and communication among the laparoscopy team: surgeons, pediatricians, cardiologists, pulmonologist and anesthesiologists in this case cannot be overemphasized.
Human ; Female ; Child Preschool ; PEDIATRICS ; NEPHRECTOMY, LAPAROSCOPY ; LAPAROSCOPY ; URINARY INCONTINENCE ;

PURPOSE: The aim of this research was to compare surgical outcomes and complications of obese and non-obese patients who underwent open radical nephrectomy (ORN) and laparoscopic radical nephrectomy (LRN). MATERIALS AND METHODS: The data of 26 ORN patients and 30 LRN patients between January 2006 and December 2008 were analyzed. Patients with a body mass index (BMI) of 25.0 kg/m2 or more were defined as obese, and those with a BMI of <25.0 kg/m2 were defined as non-obese. All patients were divided into two groups according to the criteria above to compare demographic and clinical and pathologic parameters. RESULTS: The mean BMIs of the 15 obese patients in the ORN group and the 13 obese patients in the LRN group were 26.8+/-1.1 and 27.7+/-2.4, respectively. LRN was enormously effective for lowering estimated blood loss (EBL) and postoperative days compared with ORN. Operation times and EBL in ORN were affected by obesity, both of which were increased. In contrast, the data of both LRN groups indicated similar outcomes. The perioperative data of obese patients revealed LRN to have reduced blood loss (143.0+/-62.7 vs. 446.7+/-222.4 ml, p=0.001) and not significantly different postoperative days (7.3+/-2.2 vs. 8.4+/-1.5 days, p=0.065). Operation time, however, did not differ significantly among obese patients between ORN and LRN. The complications due to LRN had no relation with obesity, whereas ORN had an increased complications rate (34.6% vs. 3.8%). CONCLUSIONS: This study shows that LRN is more effective than ORN for both obese and non-obese patients with regard to perioperative outcomes and complication rates.
Body Mass Index ; Carcinoma, Renal Cell ; Humans ; Laparoscopy ; Nephrectomy ; Obesity

PURPOSE: Laparoscopic renal surgery in urology is a rapidly evolving field that is becoming part of the operative repertoire of an increasing number of urologists. This article summarized the latest ideas and issues in the expanding field of laparoscopy in urology. MATERIALS AND METHODS: The state of art is reviewed, including transperitoneal laparoscopic and hand-assisted techniques, as well as the retroperitoneal approach. Operative and postoperative data are reviewed with the goal of determining factors; the efficacy, efficiency and morbidity. RESULTS: Continued demonstration of reduced postoperative pain, shorter hospital stay, and more rapid recovery along with decreasing operative times have made laparoscopy the preferred approach for the surgical removal of benign and maligant kidneys. In addition, maturing data for laparoscopic radical nephrectomy, nephroureterectomy and partial nephrectomy demonstrate equivocal oncologic results. CONCLUSIONS: Evolving techniques and equipment will help secure laparoscopic renal surgery a prominent place in the treatment of renal diseases.
Kidney ; Laparoscopy* ; Length of Stay ; Nephrectomy ; Operative Time ; Pain, Postoperative ; Urology

The water-jet system (WJS) can be used for selective dissection of kidney parenchyma without renal artery clamping in laparoscopic partial nephrectomy (LPN). We report our experiences regarding LPN with a WJS. The first case was a 59 year old male with a 1.8 cm solid mass in the Rt. mid-lateral area (R.E.N.A.L score: 5a). The second case was a 24 year old female with a 2.3cm solid mass in the Lt. mid-lateral area (R.E.N.A.L score: 7x). We successfully finished non-clamping LPN using a WJS without perioperative complications. Surgical margins were negative (7mm and 1mm for cases 1 and 2, respectively). Post-operative renal function was not decreased significantly. LPN using a WJS is a feasible and safe technique which can be performed for small renal masses without ischemic damage.
Constriction ; Female ; Humans ; Kidney ; Laparoscopy ; Male ; Nephrectomy* ; Renal Artery ; Water*

A single dysplastic ectopic kidney associated with ectopic ureter or ureterocele defies detection even with repeated examinations using conventional imaging modalities and cystovaginoscopy under anesthesia, thus leading to significant delay in diagnosis and appropriate treatment. Laparoscopy can be a useful modality for the diagnosis, and also the treatment, of small ectopic kidney not found with conventional diagnostic method. We report three cases of transperitoneal laparoscopic nephrectomy for ectopic dysplastic kidney.
Anesthesia ; Choristoma ; Diagnosis ; Kidney* ; Laparoscopy ; Nephrectomy* ; Ureter ; Ureterocele

We describe our initial experience with embryonic-natural orifice transluminal endoscopic surgery (E-NOTES) nephrectomy in a nonfunctioning kidney. E-NOTES was performed with modified single port access by using a surgical glove and wound retractor. We used several laparoscopic instruments, such as articulating laparoscopic instruments, clips, conventional laparoscopic graspers, and dissectors. The operative time was 80 minutes. There were no intraoperative complications.
Gloves, Surgical ; Intraoperative Complications ; Kidney ; Laparoscopy ; Nephrectomy ; Operative Time

OBJECTIVETo review published literatures comparing the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy (RLPN) with transperitoneal laparoscopic partial nephrectomy (TLPN) and provide reference for clinical work.

METHODSThe search strategy was performed to identify relevant papers from the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, Google Scholar, China Hospital Knowledge Database, Wangfang Chinese Periodical Database, and VIP Chinese Periodical Database. All papers comparing RLPN with TLPN were included from 2000 to 2015. Two to three reviewers independently screened, evaluated, and extracted the included papers. A Meta-analysis was executed by using Review Manager 5.3 software. The interesting outcomes were tumor size, operating time, estimated blood loss, warm ischaemia time, length of hospital stay, positive margin rate, open conversion rate, overall complication rate, and recurrence rate.

RESULTSThe literature search obtained 378 papers, then 10 of them were ultimately met the inclusion criteria and included in the systematic review. Finally, 6 of the 10 papers were included in the Meta-analysis. RLPN had significantly less operating time [P = 0.01, mean difference (MD)=-33.68, 95% confidence interval (CI) within (-60.35, -7.01)] and shorter length of hospital stay [P < 0.0001, MD=-1.47, 95% CI within (-2.18, -0.76)] than TLPN. Significant differences were not found between RLPN and TLPN in other outcomes.

CONCLUSIONSRLPN may be equally safe and be faster than TLPN. Each center can choose a modality according to your own operating habits and experience.