[Show abstract][Hide abstract] ABSTRACT: Members of the urokinase-type plasminogen activator (uPA) system including uPA, its receptor uPAR and the plasminogen activator inhibitor 1 (PAI-1) play an important role in tumour invasion and progression in a variety of tumour types. Since the majority of clear cell renal cell carcinoma (ccRCC) shows distant metastasis at time of diagnosis or later, the interplay of uPA, uPAR and PAI-1 might be of importance in this process determining the patients' outcome.
Corresponding pairs of malignant and non-malignant renal tissue specimens were obtained from 112 ccRCC patients without distant metastasis who underwent tumour nephrectomy. Tissue extracts prepared from fresh-frozen tissue samples by detergent extraction were used for the determination of antigen levels of uPA, uPAR and PAI-1 by ELISA. Antigen levels were normalised to protein concentrations and expressed as ng per mg of total protein.
Antigen levels of uPA, uPAR, and PAI-1 correlated with each other in the malignant tissue specimens (rs=0.51-0.65; all P<0.001). Antigen levels of uPA system components were significantly higher in tissue extracts of non-organ confined tumours (pT3+4) compared to organ-confined tumours (pT1+2; all P<0.05). Significantly elevated levels of uPAR and PAI-1 were also observed in high grade ccRCC. When using median antigen levels as cut-off points, all three uPA system factors were significant predictors for disease-specific survival (DSS) in univariate Cox's regression analyses. High levels of uPA and uPAR remained independent predictors for DSS with HR=2.86 (95%CI 1.07-7.67, P=0.037) and HR=4.70 (95%CI 1.51-14.6, P=0.008), respectively, in multivariate Cox's regression analyses. A combination of high antigen levels of uPA and/or uPAR further improved the prediction of DSS in multivariate analysis (HR=14.5, 95%CI 1.88-111.1, P=0.010). Moreover, high uPA and/or uPAR levels defined a patient subgroup of high risk for tumour-related death in ccRCC patients with organ-confined disease (pT1+2) (HR=9.83, 95%CI 1.21-79.6, P=0.032).
High levels of uPA and uPAR in tumour tissue extracts are associated with a significantly shorter DSS of ccRCC patients without distant metastases.
BMC Cancer 12/2014; 14(1):974. · 3.32 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present our first minilaparoscopic-assisted laparoendoscopic single-site bilateral nephrectomies (b-LESS-N) performed in a patient with bilateral atrophic kidney, right malignant renal tumor of 4.5 cm that developed in a native kidney after multiple bilateral renal transplantations and renovascular hypertension. The mean operative time was 233 minutes, with a mean blood loss of 180 mL. A single umbilical incision (5.5 cm) was performed to remove both kidneys. No significant difference in glomerular filtration rate was observed postoperatively. The postoperative recovery was uneventful with favorable short-term outcomes and high patient satisfaction. The 10-month follow-up showed effective arterial pressure improvement, absence of tumor relapse, and stable graft function. We believe that b-LESS-N for renal cancer after a renal transplantation can be performed without increased risks for the patients or for the transplanted kidney.
[Show abstract][Hide abstract] ABSTRACT: 2008) Sofort-und Spätfunktion des Transplantats nach laparoskopisch-handassistierter Donornephrektomie: Vergleich zur offenen Donornephrekto-mie. Tx Med 20: 13-17 Sofort-und Spätfunktion des Transplantats nach laparoskopisch-handassistierter Donor-nephrektomie: Vergleich zur offenen Donornephrektomie Einleitung: Die laparoskopische Donornephrektomie hat sich zum Verfahren der Wahl in der Lebendnieren-Transplantation entwi-ckelt. Längere Warm-Ischämiezeit und Anwendung des Pneumope-ritoneums ließen zuletzt Fragen über die Sofort-und Spätfunktion des Transplantats aufkommen. Wir berichten über unsere Erfahrun-gen mit laparoskopisch-handassistierter Donornephrektomie, ins-besondere betreffend der Transplantatfunktion verglichen mit offe-ner Donornephrektomie. Patienten und Methoden: Diese Studie ist eine retrospektive, nicht-randomisierte Single-center Analyse. Zwischen 1995 und März 2008 wurde bei 72 Patienten mit terminaler Niereninsuffi-zienz eine Lebendspende-Niere transplantiert. Davon waren 35 Donornieren offen-chirurgisch und 37 laparoskopisch-handassis-tiert entnommen. Erfasst wurden neben der Transplantat-Sofort-funktion die biochemischen Marker der glomerulären Filtrations-rate (GFR), Serum-Creatinin und Serum-Cystatin C 1 Jahr nach Transplantation. Ergebnisse: Sowohl die Rate der Transplantat-Sofortfunktion als auch die Nierenfunktionsparameter Serum-Creatinin und Serum-Cystatin C ein Jahr nach Transplantation zeigten in beiden Patien-tengruppen keinen statistisch signifikanten Unterschied. Schlussfolgerungen: Die laparoskopisch-handassistierte Donor-nephrektomie hatte verglichen mit offener Donornephrektomie kei-nen negativen Einfluss auf die Transplantatfunktion des Lebend-spende-Empfängers. Introduction: The laparoscopic donor nephrectomy has become the procedure of choice in the living related kidney transplantation. Longer warm ischemia time and application of pneumoperitoneum have raised questions about the early and late function of the trans-plant graft. We report on our experience with laparoscopic hand-assisted donor nephrectomy, in particular concerning the graft function compared with open donor nephrectomy.
[Show abstract][Hide abstract] ABSTRACT: In der vorliegenden Arbeit wird ein Überblick zum Einsatz laparoskopischer Operationstechniken bei “marginalen” Patienten
gegeben, die insbesondere durch die Faktoren “fortgeschrittenes Alter” und “Niereninsuffizienz” gekennzeichnet sind. Die Laparoskopie
muss sich an der technischen Machbarkeit, aber auch an (post)operativen Parametern im Vergleich zum (offenen) Standardeingriff
messen lassen. Vor allem für die laparoskopische Nephrektomie dürfte ein Großteil dieser Anforderungen als geprüft und überwiegend
positiv beurteilt gelten.
Dennoch liegen nur wenige Publikationen zur laparoskopischen Nephrektomie bei sehr alten Patienten oder Patienten mit Niereninsuffizienz
vor. Die Belastung durch das Pneumoperitoneum dürfte einen spezifischen Faktor der Laparoskopie darstellen und mag im Einzelfall
den offenen Eingriff als geeigneter erscheinen lassen. Hiervon abgesehen zeigt die Analyse der verfügbaren Literatur, dass
die Effektivität der Laparoskopie auch bei Vorliegen eines gewissen Risikoprofils bestehen bleibt. Gerade marginale Patienten
dürften von den Vorteilen profitieren, die insbesondere im postoperativen Verlauf evident sind. Obgleich die Datenlage hinsichtlich
anderer urologischer Operationen spärlicher ist, dürften die Ergebnissen der laparoskopischen Nephrektomie prinzipiell auch
auf andere Eingriffe übertragbar sein.
This paper describes the use of urological laparoscopy in borderline patients, focussing on geriatric patients and those with
renal failure. Laparoscopy must not only be feasible but also at least as effective concerning operative and postoperative
parameters when compared to standard open surgery. For laparoscopic nephrectomy most of these factors have tested positive.
However, only a few papers have been published concerning borderline patients. In some cases the pneumoperitoneum may not
be suitable for borderline patients and open operative techniques are preferred. Apart from this, the current literature supports
the effectiveness of laparoscopy even when certain risk factors are present.
Especially borderline patients can benefit from the laparoscopic approach for nephrectomy. Although data are scarce concerning
other laparoscopic procedures in borderline patients, the results of laparoscopic nephrectomy should probably apply to other
Der Urologe 03/2014; 41(2):123-130. · 0.44 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Renal transplantation represents actually the most effective therapy in patients with end-stage renal failure as it is cost effective, allows for a normal life style and reduces the risk of mortality from dialysis related complications. Renal transplantation can be classified in deceased- donor or living-donor transplantation, depending on the source of the donor organ. The short-term results of transplants with kidneys from donors over 65 years old are almost similar to those with younger organs, but in these patients it is mandatory to reduce cold ischemia time. In the last years, the demand for kidney transplantation has increased dramatically, which has been associated with an increase in living-donor organ procurement, which presents several advantages. Moreover, new operative techniques have been recently developed in order to improve surgical outcomes and graft survival and to reduce the complications' rate after renal transplantation. The purpose of the present review is to evaluate the published literature regarding the technical aspects and the urological complications associated with renal transplantation.
[Show abstract][Hide abstract] ABSTRACT: To analyse intraoperative costs and healthcare reimbursements of partial/radical nephrectomy in open and minimal invasive surgery (MIS), as laparoscopy and laparoendoscopic single-site surgery (LESS), for the treatment of renal tumour.
In a non-randomized retrospective study, we selected 90 patients who underwent (01/2010-12/2011) partial and radical nephrectomy for clinical renal masses ≤7 cm (cT1N0M0) and divided them into laparoscopic [laparoscopic partial nephrectomy (LPN), laparoscopic radical nephrectomy (LRN)], LESS [laparoendoscopic single-site partial nephrectomy (LESS-PN), laparoendoscopic single-site radical nephrectomy (LESS-RN)] and open groups [open partial nephrectomy (OPN), open radical nephrectomy (ORN)]. Patients were matched for age, sex, body mass index, ASA score and tumour side. Primary endpoints were evaluation of intraoperative costs (general, laparoscopic, sutures, haemostatic agents, anaesthesia, and surgeon/nurses fee), total insurance and estimated daily reimbursement.
MIS showed longer operative time (p ≤ .02) and shorter hospital stay (p ≤ .04). Total costs were higher (p ≤ .03) in MIS (LRN: 4,091.5 ; LPN: 4,390.4 ; LESS-RN: 3,866 ; and LESS-PN: 3,450 ) if compared with open (OPN: 2,216.8.8 , ORN: 1,606.4 ). Laparoscopic materials incised mainly in total costs of MIS (38-58.1 %). Reusable instruments reduced LESS laparoscopic costs (LESS-PN: 1,312.2 vs. LRN: 2,212.2 , p < .0001). Intraoperative frozen section and DJ ureteric stenting (general costs) (p ≤ .008) and haemostatic agents use (p ≤ .01) were higher in nephron sparing surgery (NSS), due to more frequent use of ancillary procedures necessary for a safe management of such an approach. Estimated anaesthesia costs and doctor/nurses fee were higher in MIS (p ≤ .02). Whereas total final reimbursements were comparable (p ≥ .8), estimated daily reimbursements were lower in MIS (p < .001) due to higher intraoperative costs and longer operative time.
Well-known advantages offered by MIS/NSS face higher total intraoperative costs and 'paradoxical' reduced healthcare reimbursement. We believe that local health systems should consider a subclassification with different compensations, which will incentive NSS and MIS approaches.
World Journal of Urology 12/2013; · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Molecular imaging (MI) entails the visualisation, characterisation, and measurement of biologic processes at the molecular and cellular levels in humans and other living systems. Translating this technology to interventions in real-time enables interventional MI/image-guided surgery, for example, by providing better detection of tumours and their dimensions.
To summarise and critically analyse the available evidence on image-guided surgery for genitourinary (GU) oncologic diseases.
A comprehensive literature review was performed using PubMed and the Thomson Reuters Web of Science. In the free-text protocol, the following terms were applied: molecular imaging, genitourinary oncologic surgery, surgical navigation, image-guided surgery, and augmented reality. Review articles, editorials, commentaries, and letters to the editor were included if deemed to contain relevant information. We selected 79 articles according to the search strategy based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis criteria and the IDEAL method.
MI techniques included optical imaging and fluorescent techniques, the augmented reality (AR) navigation system, magnetic resonance imaging spectroscopy, positron emission tomography, and single-photon emission computed tomography. Experimental studies on the AR navigation system were restricted to the detection and therapy of adrenal and renal malignancies and in the relatively infrequent cases of prostate cancer, whereas fluorescence techniques and optical imaging presented a wide application of intraoperative GU oncologic surgery. In most cases, image-guided surgery was shown to improve the surgical resectability of tumours.
Based on the evidence to date, image-guided surgery has promise in the near future for multiple GU malignancies. Further optimisation of targeted imaging agents, along with the integration of imaging modalities, is necessary to further enhance intraoperative GU oncologic surgery.
[Show abstract][Hide abstract] ABSTRACT: To report a large multi-institutional series of LESS-PN and to analyze the effect on renal function and short-term oncologic outcomes.
Consecutive cases of LESS-PN done between November 2007 and March 2012 at 11 participating institutions were included in this retrospective analysis. Demographic data, main perioperative outcome parameters, and perioperative complications were gathered and analyzed. The function of the kidney was evaluated by measuring serum creatinine and estimated glomerular filtration rate (eGFR). Moreover, chronic kidney disease (CKD) of each patient was defined in stages according to National Kidney Foundation, Kidney Disease Outcomes Quality Initiative.
A total of 190 cases were included in this analysis. Mean renal tumor size was 2.6, and PADUA score 7.2. Median operative time was 170 min with a median EBL of 150 ml. A clampless technique was adopted in 70 cases (36.8%) and the median WIT was 16.5 min. PADUA score independently predicted length of WIT (low vs high score: OR 5.11, CI 1.50-17.41, p=0.009; intermediate vs high score: OR 5.13, CI 1.56-16.88, p=0.007). The overall postoperative complication rate was 14.7%. In presence of a clamping, a significant increase of serum creatinine and a significant decrease of the eGFR were observed postoperatively and at 6 months. On multivariate analysis only PADUA score was the only predicting factor. The overall survival was found to be 99%, 97%, 88% at 12, 24 and 36 month follow-up, respectively, whereas the disease-free survival was 98% at 12 and 97% at 24 and 36 month follow-up, respectively.
This study could demonstrate that LESS-PN is effective in renal function preservation and oncological control at a short and intermediate follow up interval.
[Show abstract][Hide abstract] ABSTRACT: To report the surgical outcomes of laparoscopic radical cystectomy (LRC) with extracorporeal orthotopic ileal neobladder (OIN) in patients with muscle-invasive urothelial carcinoma of the bladder (UCB).
Between October 2009 and December 2011, 37 patients with muscle-invasive UCB underwent a LRC with OIN. Indications included (a) muscle-invasive UCB T2-4a, N0-Nx, M0; (b) high-risk and recurrent non-muscle-invasive tumors; (c) T1G3 plus CIS; and (d) extensive non-muscle-invasive disease that could not be controlled by transurethral resection and intravesical therapy. Demographic data, perioperative, and postoperative variables were recorded and analyzed.
The median operating time was 330 min, with a median estimated blood loss of 410 ml. Median length of stay was 12 days, and the mean length of the skin incision to extract the specimen and for the configuration of the neobladder was 7 ± 1 cm. The complication rate was 21.6 % (Clavien II). No Clavien III-V complications were reported. Daytime and nocturnal continence were preserved in 95 and 78 %, respectively. No local recurrence or port site metastasis occurred. Median time to disease recurrence was 14 months (IQR 9-24), and 1-year cancer-specific survival was 91.9 %.
Laparoscopic radical cystectomy with extracorporeal ileal neobladder is a challenging procedure but technically feasible, allowing low morbidity and oncological safety. Long-term oncological results are required to definitely recognize this procedure as a standard treatment for bladder cancer.
World Journal of Urology 07/2013; · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Over the last few years, many urological laparoscopic operations have been successfully performed by LESS. However, the actual role of LESS in the field of minimally invasive urologic surgery remains to be determined with controversial data about postoperative pain control and almost no results on cosmetic data. The aim of the present study is to describe the technique and report the surgical outcomes of LESS radically nephrectomy (RN) in the treatment of renal cell carcinoma with special emphasis for postoperative pain control and almost no results on cosmetic data.
LESS-RN was performed in 33 patients with renal tumors. The indications to perform a LESS-RN were represented by renal tumors not greater than T2, and without evidence of lymphadenopathy or renal vein involvement.
The Endocone (Karl Storz, Tuttlingen, Germany) was inserted through a transumbilical incision. A combination of standard laparoscopic instruments and bent grasper and scissors was used. The step sequence of LESS-RN was comparable to standard laparoscopic RN. Demographic data and perioperative and postoperative variables were recorded and analyzed.
The mean operative time was 143.7 ± 24.3 min, with a mean estimated blood loss of 122.3 ± 34.1 mL and a mean hospital stay of 3.8 ± 0.8 d. The mean length of skin incision was 4.1 ± 0.6 cm; all patients were discharged from hospital with minimal discomfort, as demonstrated by their pain assessment scores (visual analogue scale: 1.9 ± 0.8). The definitive pathologic results revealed a renal cell carcinoma in all cases and a stage distribution of four T1a, 27 T1b, and 2 T2 tumors. All patients were very satisfied with the appearance of the scars, and at a median follow-up period of 13.2 ± 3.9 mo, all patients were alive without evidence of tumor recurrence or port-site metastasis.
LESS is a safe and feasible surgical procedure for RN in the treatment of renal cell carcinoma and has excellent cosmetic results.
[Show abstract][Hide abstract] ABSTRACT: Vom 10. bis zum 12. November 2011 fand in Mainz die 19. Jahrestagung des Arbeitskreises Nierentransplantation (NTX) der Akademie der Deutschen Urologen statt. Diesjährige Schwerpunkte waren operativ-technische Aspekte, die immunsuppressive Therapie, Transplantatabstoßung, Schwangerschaft, Sexualität und psychologische Konflikte von Nierentransplantierten. Die Vortragenden dokumentierten die Relevanz der Interdisziplinarität für die NTX und kamen außer aus der Urologie aus den Fachbereichen Anästhesie, Gynäkologie, Chirurgie, Dermatologie, Nephrologie, Radiologie und der psychosomatischen Medizin. Zum Abschluss der Veranstaltung wurde der Bernd-Schönberger-Preis 2011 verliehen.
[Show abstract][Hide abstract] ABSTRACT: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: LESS-NU may be an alternative minimally-invasive treatment option for patients eligible to undergo laparoscopic surgery for upper urinary tract urothelial carcinoma. The true benefits of LESS-NU remain to be determined and require randomized control trials in the future. Despite encouraging early findings, clinical trials still are warranted before this procedure is adopted widely, and longer follow-up is needed to determine its oncological durability. OBJECTIVE: To report a large multi-institutional series of laparoendoscopic single-site (LESS) nephroureterectomy (NU). MATERIALS AND METHODS: Data on all cases of LESS-NU performed between 2008 and 2012 at 15 institutions were retrospectively gathered. The main demographic data and perioperative outcomes were analysed. RESULTS: The study included 101 patients whose mean (sd) age was 66.4 (9.9) years and mean (sd) body mass index was 24.8 (4) kg/m2 , and of whom 29.7% had undergone previous abdominal/pelvic surgery. The mean (sd) operating time was 221.4 (73.7) min, estimated blood loss 231.7 (348.0) mL. A robot-assisted LESS technique was applied in 25.7% of cases. An extra trocar was inserted in 28.7% of cases to complete the procedure. Conversion to open surgery was necessary in three cases (3.0%). There was no bladder cuff excision in 20.8% of cases, and excision was carried out using a variety of techniques in the remaining cases. Six intra-operative complications occurred (5.9%). The mean (sd) length of hospital stay was 6.3 (3.5) days. The overall postoperative complication rate was 10.0%, and most of the complications were low grade (Clavien grades 1 and 2). The mean tumour size was 3.1 (1.9) cm. Pathological staging was pTis in two patients, pTa in 12 patients, pT1 in 42 patients, pT2 in 20 patients, pT3 in 23 patients and pT4 in two patients. Pathological grade was high in 71 and low in 30 patients. At a mean follow-up of 14 months, six patients (5.9%) had died. Disease recurrence (including distant and bladder recurrence) was detected in 22.8% of patients, with a mean time to recurrence of 11.5 months. CONCLUSIONS: This study reports the largest multi-institutional experience of LESS-NU to date. Peri-operative outcomes mirror those of published standard laparoscopy series. Despite encouraging early findings, longer follow-up is needed to determine the oncological efficacy of the procedure.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To evaluate the surgical and functional outcomes in nerve-sparing laparoscopic radical prostatectomy (nsLRPT) and nerve-sparing retropubic radical prostatectomy (nsRRPT) after TUR-P for incidental prostate cancer. MATERIALS AND METHODS: Between January 2003 and August 2011, 125 nsLRPT and 128 nsRRPT for incidental prostate cancer diagnosed after TUR-P were performed at our clinic. Demographic data, peri- and postoperative measurements and functional outcomes were compared. RESULTS: The mean operative time was 153.1 ± 35.4 min for nsLRPT and 122.5 ± 67.5 min for nsRRPT (p = 0.03). The mean catheterization time was 8 ± 1 days in the laparoscopic group and 11 ± 2 days in the open group (p = 0.02). Also, the length of hospitalization presents statistical significant difference in the two groups. Positive margins were detected in 2.4 and 4.7 % of patients with pT2c tumours in the laparoscopic and open groups, respectively (p = 0.09). At a mean follow-up of 26.9 ± 9.3 months for the nsLRPT group and of 27.8 ± 9.7 months for the nsRRPT group, all patients were alive with no evidence of tumour recurrence. Twelve months postoperatively, complete continence was reported in 96.8 % of patients who underwent an nsLRPT and in 89.4 % of patients in the nsRRPT group (p = 0.02). At that time, 74.4 % of patients in the nsLRPT group and 53.1 % in the nsRRPT group reported the ability to engage in sexual intercourse (p = 0.0004). CONCLUSION: nsLRPT after TUR-P, performed by expert surgeons, results to be a safe procedure with excellent functional outcomes with regard to the urinary continence and sexual potency.
World Journal of Urology 02/2013; · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Laparoendoscopic single-site surgery (LESS) has been developed in an attempt to further reduce the surgical trauma associated with conventional laparoscopy. Partial nephrectomy (PN) represents a challenging indication for LESS. OBJECTIVE: To report a large multi-institutional series of LESS-PN and to analyze the predictors of outcomes after LESS-PN. DESIGN, SETTING, AND PARTICIPANTS: Consecutive cases of LESS-PN done between November 2007 and March 2012 at 11 participating institutions were included in this retrospective analysis. INTERVENTION: Each group performed LESS-PN according to its own protocols, entry criteria, and techniques. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Demographic data, main perioperative outcome parameters, and perioperative complications were gathered and analyzed. A multivariable analysis was used to assess the factors predicting a short (≤20min) warm ischemia time (WIT), the occurrence of postoperative complication of any grade, and a favorable outcome, arbitrarily defined as a combination of the following events: short WIT plus no perioperative complications plus negative surgical margins plus no conversion to open surgery or standard laparoscopy. RESULTS AND LIMITATIONS: A total of 190 cases were included in this analysis. Mean renal tumor size was 2.6, and PADUA score 7.2. Median operative time was 170min, with median estimated blood loss (EBL) of 150ml. A clampless technique was adopted in 70 cases (36.8%), and the median WIT was 16.5min. PADUA score independently predicted length of WIT (low vs high score: odds ratio [OR]: 5.11 [95% confidence interval (CI), 1.50-17.41]; p=0.009; intermediate vs high score: OR: 5.13 [95% CI, 1.56-16.88]; p=0.007). The overall postoperative complication rate was 14.7%. The adoption of a robotic LESS technique versus conventional LESS (OR: 20.92 [95% CI, 2.66-164.64]; p=0.003) and the occurrence of lower (≤250ml) EBL (OR: 3.60 [95% CI, 1.35-9.56]; p=0.010) were found to be independent predictors of no postoperative complications of any grade. A favorable outcome was obtained in 83 cases (43.68%). On multivariate analysis, the only predictive factor of a favorable outcome was the PADUA score (low vs high score: OR: 4.99 [95% CI, 1.98-12.59]; p<0.001). Limitations of the study were the retrospective design and different selection criteria for the participating centers. CONCLUSIONS: LESS-PN can be safely and effectively performed by experienced hands, given a high likelihood of a single additional port. Anatomic tumor characteristics as determined by the PADUA score are independent predictors of a favorable surgical outcome. Thus patients presenting tumors with low PADUA scores represent the best candidates for LESS-PN. The application of a robotic platform is likely to reduce the overall risk of postoperative complications.
[Show abstract][Hide abstract] ABSTRACT: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Laparoendoscopic single-site (LESS) surgery has proved to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons in well-selected patients. All extirpative and reconstructive urological procedures have been described in the literature, but LESS partial nephrectomy (PN) is one of the most complex procedures and few studies have been published on this subject. The study describes a clampless technique for LESS PN, by reducing the blood pressure and increasing the intra-abdominal pressure of the pneumoperitoneum to 20 mmHg, timed to precisely coincide with excision of the tumour. This technique was found to be safe and feasible in the treatment of low-risk T1a RCC. OBJECTIVE: To describe the technique and report the surgical outcomes of clampless laparoendoscopic single-site (LESS) partial nephrectomy (PN) in the treatment of renal cell carcinoma (RCC) with low PADUA score. PATIENTS AND METHODS: Clampless LESS PN was performed in 14 patients with cT1a renal tumours. Indications to perform a clampless LESS PN were low-risk, laterally based renal tumours, located away from the renal hilum, with a PADUA score ≤7. Demographic data and peri-operative and postoperative variables were recorded and analysed. Kidney function was evaluated by measuring serum creatinine concentration and estimated glomerular filtration rate (eGFR) pre- and postoperatively and at 6-month follow-up. RESULTS: The median operating time was 120 min and warm ischaemia time was zero in all cases. Only one early complication (Clavien grade 1) was recorded: one patient developed a flank haematoma which it was possible to treat by conservative therapy. Serum creatinine and modification of diet renal disease eGFR were not found to be significantly different pre- and postoperatively and at 6-month follow-up. Definitive pathological results showed 12 pT1a RCCs and two pT1a-chromophobe RCCs. All tumours were removed with negative surgical margins. All patients were satisfied with the cosmetic results. At a median (range) follow-up period of 12 (8-15) months, all patients were alive without evidence of tumour recurrence or port-site metastasis. CONCLUSION: Clampless LESS PN is a safe and feasible surgical procedure in the treatment of low-risk T1a RCC, with excellent cosmetic results.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: Laparoendoscopic single-site surgery (LESS) represents an evolution of laparoscopy for the treatment for urologic diseases. The aim of this study is to investigate the feasibility of LESS in patients with increased comorbidities and previous abdominal surgery undergoing radical nephrectomy (LESS-RN) for renal cell carcinoma. MATERIALS AND METHODS: A total of 25 patients with increased comorbidities and previous abdominal surgery who underwent LESS-RN were compared to 31 patients with the same characteristics after conventional laparoscopic radical nephrectomy (LRN). LRN was performed between January 2009 and May 2010, and LESS-RNs were performed between June 2010 and November 2011. Demographic data and perioperative and postoperative variables were recorded and analysed. RESULTS: The mean ASA score in the LESS-RN and LRN groups was 3.2 ± 0.4, and the mean BMI was 32.7 ± 2.1 and 34.2 ± 0.8 kg/m(2), respectively. The mean operative time in the LESS-RN and LRN groups was 143.7 ± 24.3 and 130.6 ± 26.5 min, (p = 0.11), and the mean hospital stay was 3.8 ± 0.8 versus 4.2 ± 1.4 days in the two groups (p = 0.06), respectively. Three and four complications were recorded in the LESS-RN and in the LRN groups, for a mean complication rate of 12 and 12.9 % (p = 0.12), respectively All tumours were organ-confined with negative surgical margins, and the mean R.E.N.A.L nephrometry score for LESS-RN and LRN was 9.78 ± 1.7 and 9.82 ± 1.3 (p = 0.14), respectively. CONCLUSIONS: LESS-RN in patients with increased comorbidities and previous abdominal surgery is equally effective as LRN without compromising on surgical, oncologic short-term and postoperative outcomes.
World Journal of Urology 12/2012; · 3.42 Impact Factor