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Background: Robot-assisted laparoscopic partial nephrectomy (RAPN) for renal tumor treatment provides ergonomic advantages to surgeons and improves surgical outcomes. However, moderate-to-severe pain is unavoidable even after minimally invasive surgery. Despite the growing interest in multimodal analgesia, few studies have directly compared its efficacy with intrathecal morphine, a traditional opioid-based analgesic. Methods: We retrospectively investigated the efficacy of multimodal analgesia compared with that of intrathecal analgesia and intravenous patient-controlled analgesia (IV-PCA) in patients who underwent transperitoneal RAPN at our institute between 2020 and 2022. Among the 334 patients who met the inclusion criteria, intrathecal analgesia using morphine 200 µg was performed in 131 patients, and multimodal analgesia, including transversus abdominis plane block and intraoperative infusion of paracetamol 1 g and nefopam 20 mg, was administered to 105 patients. The remaining 98 patients received postoperative IV-PCA alone. Results: As the primary outcome, the area under the curve of pain scores over 24 h was significantly lower in the intrathecal analgesia and multimodal analgesia groups than in the IV-PCA group (89 [62-108] vs. 86 [65-115] vs. 108 [87-126] h, p < 0.001). Cumulative opioid requirements were also significantly lower in the intrathecal analgesia and multimodal analgesia groups at 24 h after surgery (p < 0.001). However, postoperative nausea and vomiting were significantly increased in the intrathecal analgesia group (27.5% vs. 13.3% vs. 13.3%, p = 0.005). Conclusions: Multimodal analgesia with a transversus abdominis plane block is an efficient analgesic method with fewer adverse effects compared to other analgesic methods. Our findings suggest the efficacy and safety of a multimodal approach for opioid-sparing analgesia after RAPN in the current opioid epidemic.

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This study aimed to compare the efficacy of percutaneous microwave ablation therapy (MWAT) and laparoscopic partial nephrectomy (LPN) in early-stage renal cell carcinoma (RCC) classified as T1a; a retrospective analysis was conducted on patients treated between January 2017 and November 2023. Oncological outcomes, radiological recurrence, length of stay (LOS), and costs were evaluated. The study included 110 patients, with no significant differences between the two groups regarding residual tumors, local tumor progression, and disease-free survival rates (p > 0.05). The LPN group showed significantly lower pre/postoperative serum urea and creatinine and higher estimated glomerular filtration rate values, whereas the MWA group experienced significantly lower mean costs, complication rates, LOS in the hospital, and procedure durations (p ≤ 0.05). However, post-procedure residual tumors and local tumor progression rates did not differ significantly between the LPN and MWAT groups (p > 0.05). MWAT is as effective as LPN for T1a RCC lesions. In addition, MWAT has lower costs than LPN and is a cost-effective treatment method. Therefore, MWAT minimizes hospital stay and complications and since the oncological results are similar to LPN, it might be considered as the first choice of treatment in young patients.

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BACKGROUND: This study aimed to compare the benefits and safety of microwave scissors-based sutureless laparoscopic partial nephrectomy (MSLPN) with those of conventional open partial nephrectomy (cOPN). METHODS: Each kidney in nine pigs underwent MSLPN using microwave scissors (MWS) via transperitoneal laparoscopy or cOPN via retroperitoneal open laparotomy. The kidney's lower and upper poles were resected under temporary hilar-clamping. The renal calyces exposed during renal resections were sealed and transected using MWS in MSLPN and were sutured in cOPN. For MWS, the generator's power output was 60 W. Data on procedure time (PT), ischemic time (IT), blood loss (BL), normal nephron loss (NNL), and extravasation during retrograde pyelogram were compared between the two techniques. RESULTS: The authors successfully performed 22 MSLPNs and 10 cOPNs. Compared with cOPN, MSLPN was associated with significantly lower PT (median, 9.2 vs 13.0 min; p = 0.026), IT (median, 5.9 vs 9.0 min; p < 0.001), BL (median, 14.4 vs 38.3 mL; p = 0.043), and NNL (median, 7.6 vs 9.4 mm; p = 0.004). However, the extravasation rate was higher in the MSLPN group than in the cOPN group (54.5 % [n = 12] vs 30.0 % [n = 3]), albeit without a significant difference (p = 0.265). Pelvic stenosis occurred in one MSLPN procedure that involved deep lower pole resection near the kidney hilum. CONCLUSIONS: The study data show that MSLPN can improve intraoperative outcomes while reducing technical demands for selected patients with non-hilar-localized renal tumors. However, renal calyces, if violated, should be additionally sutured to prevent urine leakage.

Asunto(s)

Laparoscopía , Microondas , Nefrectomía , Animales , Nefrectomía/métodos , Laparoscopía/métodos , Porcinos , Microondas/uso terapéutico , Complicaciones Posoperatorias/etiología , Neoplasias Renales/cirugía , Neoplasias Renales/patología , Tempo Operativo , Femenino , Instrumentos Quirúrgicos

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BACKGROUND: This study was designed to develop an innovative classification and guidance system for renal hilar tumors and to assess the safety and effectiveness of robot-assisted partial nephrectomy (RAPN) for managing such tumors. METHODS: A total of 179 patients undergoing RAPN for renal hilar tumors were retrospectively reviewed. A novel classification system with surgical techniques was introduced and the perioperative features, tumor characteristics, and the efficacy and safety of RAPN were compared within subgroups. RESULTS: We classified the tumors according to our novel system as follows: 131 Type I, 35 Type II, and 13 Type III. However, Type III had higher median R.E.N.A.L., PADUA, and ROADS scores compared with the others (all p < 0.001), indicating increased operative complexity and higher estimated blood loss [180.00 (115.00-215.00) ml]. Operative outcomes revealed significant disparities between Type III and the others, with longer operative times [165.00 (145.00-200.50) min], warm ischemia times [24.00 (21.50-30.50) min], tumor resection times [13.00 (12.00-15.50) min], and incision closure times [22.00 (20.00-23.50) min] (all p < 0.005). Postoperative outcomes also showed significant differences, with longer durations of drain removal (77.08 ± 18.16 h) and hospitalization for Type III [5.00 (5.00-6.00) d] (all p < 0.05). Additionally, Type I had a larger tumor diameter than the others (p = 0.009) and pT stage differed significantly between the subtypes (p = 0.020). CONCLUSIONS: The novel renal hilar tumor classification system is capable of differentiating the surgical difficulty of RAPN and further offers personalized surgical steps tailored to each specific classification. It provides a meaningful tool for clinical practice.

Asunto(s)

Neoplasias Renales , Nefrectomía , Procedimientos Quirúrgicos Robotizados , Humanos , Neoplasias Renales/cirugía , Neoplasias Renales/clasificación , Neoplasias Renales/patología , Femenino , Masculino , Nefrectomía/métodos , Estudios Retrospectivos , Persona de Mediana Edad , Procedimientos Quirúrgicos Robotizados/métodos , Estudios de Seguimiento , Anciano , Tempo Operativo , Pronóstico , Complicaciones Posoperatorias/clasificación , Complicaciones Posoperatorias/etiología , Tiempo de Internación/estadística & datos numéricos , Adulto , Carcinoma de Células Renales/cirugía , Carcinoma de Células Renales/patología , Carcinoma de Células Renales/clasificación , Isquemia Tibia , Pérdida de Sangre Quirúrgica/estadística & datos numéricos

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BACKGROUND: To evaluate the predictive value of individual components of the R.E.N.A.L scoring system for Laparoscopic (LPN) and Robotic Partial Nephrectomy (RPN). METHODS: Patients that had undergone a Laparoscopic (LPN) or Robotic Partial Nephrectomy (RPN) between 2018 and 2023 were reviewed. Our data collection included Race, Ethnicity, Age, BMI, R.E.N.A.L nephrometry score, and complications. Cases that achieved trifecta outcomes were designated as "Group A" and cases that did not achieve trifecta were "Group B". All the data were collected using REDCap database. RESULTS: A total of 111 cases were included, Group A consisted of 82% of all cases, whereas Group B 18%. Radius score demonstrated significant distinction concerning trifecta attainment and was the most predictive component of the 5 scoring metrics of the nephrometry system. In a subgroup analysis, R-score of 3 or a renal mass measuring ≥ 7 cm, was a significant independent negative predictor for trifecta outcomes, as well as tumor size at presentation. CONCLUSION: Renal nephrometry score is predictive of trifecta outcomes for patients undergoing laparoscopic or robotic partial nephrectomy. Radius of mass was the most effective predictive component of the nephrometry score for trifecta prediction.

Asunto(s)

Neoplasias Renales , Laparoscopía , Nefrectomía , Procedimientos Quirúrgicos Robotizados , Humanos , Nefrectomía/métodos , Laparoscopía/métodos , Masculino , Femenino , Persona de Mediana Edad , Neoplasias Renales/cirugía , Neoplasias Renales/patología , Resultado del Tratamiento , Anciano , Estudios Retrospectivos , Valor Predictivo de las Pruebas

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While partial nephrectomy offers oncologic efficacy and preserves renal function for T1 renal tumors, renal artery pseudoaneurysm (RAP) remains a rare but potentially life-threatening complication. This study compared RAP incidence across robotic-assisted (RAPN), laparoscopic (LPN), and open (OPN) partial nephrectomies in a large tertiary oncological center. This retrospective study analyzed 785 patients undergoing partial nephrectomy between 2012 and 2022 (398 RAPN, 122 LPN, 265 OPN). Data included demographics, tumor size/location, surgical type, clinical presentation, treatment, and post-operative outcomes. The primary outcome was RAP incidence, with secondary outcomes including presentation, treatment efficacy, and renal function. Seventeen patients (2.1%) developed RAP, presenting with massive hematuria (100%), hemorrhagic shock (5.8%), and clot retention (23%). The median onset was 12 days postoperatively. RAP occurred in 4 (1%), 4 (3.3%), and 9 (3.4%) patients following RAPN, LPN, and OPN, respectively (p = 0.04). Only operative length and surgical approach were independently associated with RAP. Selective embolization achieved immediate bleeding control in 94%, with one patient requiring a second embolization. No additional surgery or nephrectomy was needed. Estimated GFR at one year was similar across both groups (p = 0.53). RAPN demonstrated a significantly lower RAP incidence compared to LPN and OPN (p = 0.04). Emergency angiographic embolization proved effective, with no long-term renal function impact. This retrospective study lacked randomization and long-term follow-up. Further research with larger datasets and longer follow-ups is warranted. This study suggests that robotic-assisted partial nephrectomy is associated with a significantly lower risk of RAP compared to traditional approaches. Emergency embolization effectively treats RAP without compromising long-term renal function.

Asunto(s)

Aneurisma Falso , Neoplasias Renales , Laparoscopía , Nefrectomía , Complicaciones Posoperatorias , Arteria Renal , Procedimientos Quirúrgicos Robotizados , Humanos , Nefrectomía/métodos , Nefrectomía/efectos adversos , Aneurisma Falso/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Masculino , Femenino , Persona de Mediana Edad , Laparoscopía/métodos , Laparoscopía/estadística & datos numéricos , Estudios Retrospectivos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Anciano , Arteria Renal/cirugía , Neoplasias Renales/cirugía , Incidencia , Resultado del Tratamiento , Embolización Terapéutica/métodos

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Introduction: To explore the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy (RLPN) with selective artery clamp (SAC) in patients with renal cell carcinoma (RCC). Methods: The authors recruited three men and two women who underwent RLPN for T1 RCC between December 2022 and May 2023 at a tertiary hospital. The median age of the patients was 32 years (range, 25-70 years). The tumour size ranged from 3 to 4.5 cm. The R.E.N.A.L scores were 4x, 5p, 8a, 5a, and 8ah. The median preoperative eGFR was 96.9 (74.3-105.2). Renal computed tomography angiography was performed before the surgery to evaluate the artery branches. The operation time, number of clamped arteries, warm ischaemic time (WIT), intraoperative blood loss, RCC type, postoperative hospital stay, changes in renal function, and complications were evaluated. The follow-up duration was 6 months. Results: The median operation time was 120 (75-150) minutes. One artery was clamped in four patients, while three were clamped in one patient. The median WIT was 22 (15-30) min, and the median blood loss was 150 (100-300) ml. No complications were recorded, and the resection margin was negative in all patients. The median decrease in eGFR was 6 (4-30%). Conclusions: RLPN with SAC for T1 RCC is safe and feasible in clinical practice.

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To analyze and compare the intraoperative and post-operative outcomes of "on-clamp" laparoscopic partial nephrectomy (LPN) with "preoperative super-selective angioembolization" before LPN. This randomized clinical study was conducted at Gauhati Medical College Hospital, Guwahati, India, between November 2021 and November 2023. Adult patients of either gender diagnosed with T1 renal tumors were included in the study. All patients underwent diethylenetriamine pentaacetate scan preoperatively and at 1-month follow-up. The patients were randomized using a parallel group design with an allocation ratio of 1:1 to receive either preoperative angioembolization followed by LPN or conventional "on-clamp" LPN. Demographic and baseline parameters were recorded along with pre- and post-operative data. There was no significant difference between the two groups in terms of age (P = 0.11), gender distribution (P = 0.32), body mass index (P = 0.43), preoperative hemoglobin (P = 0.34), and preoperative estimated glomerular filtration rate (eGFR; P = 0.64). One patient in the embolization group required radical nephrectomy because of accidental backflow of glue into the renal artery during embolization whereas four patients required clamping due to inadequate embolization. Preoperative super-selective embolization yielded significantly less blood loss, compared to "on-clamp" LPN (145 [50.76 mL] vs. 261 [66.12 mL], P < 0.01). There was no significant difference between post-operative eGFR (at 1 month) between the two groups (P = 0.71). Preoperative embolization offers improved outcomes in the dissection plane, total operative time, and blood loss, compared to conventional "on-clamp" LPN but has no significant effect on change in eGFR.

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Metanephric adenoma presents as a rare benign tumor in children with differentiated diagnoses: Wilms tumor or renal cell carcinoma. When confronted with small renal tumors, whether they fall into one of these three diagnostic categories, tumor resection surgery with laparoscopic partial nephrectomy is considered a viable and effective operative approach. Herein, we report the case of an 11-year-old female patient initially diagnosed with stage T1a renal cell carcinoma with postoperative pathology results confirming metanephric adenoma. Successfully treated with laparoscopic partial nephrectomy, the patient showed no signs of recurrence or metastasis during follow-up.

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The Mayo Adhesive Probability (MAP) score is a radiographic scoring system that predicts the presence of adherent perinephric fat (APF) during partial nephrectomies (PNs). The purpose of this systematic review is to summarize the current literature on the application of the MAP score for predicting intraoperative difficulties related to APF and complications in laparoscopic PNs. Three databases, PubMed, Scopus and Cochrane, were screened, from inception to 29 October 2023, taking into consideration the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines. All the inclusion criteria were met by eight studies. The total operative time was around two hours in most studies, while the warm ischemia time was <30 min in all studies and <20 min in four studies. Positive surgical margins, conversion and transfusion rates ranged from 0% to 6.3%, from 0% to 5.0% and from 0.7% to 7.5%, respectively. Finally, the majority of the complications were classified as Grade I-II, according to the Clavien-Dindo Classification System. The MAP score is a useful tool for predicting not only the presence of APF during laparoscopic PNs but also various intraoperative and postoperative characteristics. It was found to be significantly associated with an increased operative time, estimated blood loss and intraoperative and postoperative complication rates.

RESUMEN

Accurate lesion diagnosis through computed tomography (CT) and advances in laparoscopic or robotic surgeries have increased partial nephrectomy survival rates. However, accurately marking the kidney resection area through the laparoscope is a prevalent challenge. Therefore, we fabricated and evaluated a 4D-printed kidney surgical guide (4DP-KSG) for laparoscopic partial nephrectomies based on CT images. The kidney phantom and 4DP-KSG were designed based on CT images from a renal cell carcinoma patient. 4DP-KSG were fabricated using shape-memory polymers. 4DP-KSG was compressed to a 10 mm thickness and restored to simulate laparoscopic port passage. The Bland-Altman evaluation assessed 4DP-KSG shape and marking accuracies before compression and after restoration with three operators. The kidney phantom's shape accuracy was 0.436 ± 0.333 mm, and the 4DP-KSG's shape accuracy was 0.818 ± 0.564 mm before compression and 0.389 ± 0.243 mm after restoration, with no significant differences. The 4DP-KSG marking accuracy was 0.952 ± 0.682 mm before compression and 0.793 ± 0.677 mm after restoration, with no statistical differences between operators (p = 0.899 and 0.992). In conclusion, our 4DP-KSG can be used for laparoscopic partial nephrectomies, providing precise and quantitative kidney tumor marking between operators before compression and after restoration.

Asunto(s)

Neoplasias Renales , Laparoscopía , Humanos , Nefrectomía/métodos , Riñón/diagnóstico por imagen , Riñón/cirugía , Riñón/patología , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/cirugía , Laparoscopía/métodos , Impresión Tridimensional

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Objective: The aim of this study is to compare the precision and applicability of the Zhongshan (ZS) score against the radius, exophytic/endophytic, nearness, anterior/posterior, and location (RENAL) score in forecasting perioperative outcomes during laparoscopic partial nephrectomy (LPN). Materials and Methods: We retrospectively analyzed data from 99 renal cancer patients who underwent LPN between January 2017 and August 2023. Patients were scored and categorized based on both the ZS and RENAL scores. The study then compared perioperative outcomes across these groups and further investigated the correlation between ZS and RENAL scores and overall complication rates. Results: LPN was successfully accomplished in 94 patients, whereas 5 patients necessitated conversion to open or radical surgery. The high-risk group, according to the ZS score, manifested more warm ischemic time (WIT) than the low-risk group (P = .007). Furthermore, the incidence of overall complications escalated with increase in the ZS score grade (P = .045). A higher RENAL score corresponded to a greater risk of conversion to open or radical treatment (P = .012). Correlation analyses revealed associations between both ZS and RENAL scores and overall complications. The RENAL score also correlated with changes in blood creatinine values, while the ZS score was associated with WIT (all P < .05). In the univariate analysis, both ZS and RENAL scores were substantial factors for the occurrence of total complications (P = .029 and P = .027, respectively), but they were not statistically significant in the multivariate analysis. The receiver operating characteristic curves suggested that both individual and combined ZS and RENAL scores held predictive potential for the onset of overall complications (area under the curve = 0.652, 0.660, and 0.676, respectively). Conclusions: Compared with the RENAL score, the ZS score provides a more comprehensive assessment of tumor complexity in patients undergoing LPN. Integrating these two scores could potentially improve the accuracy of predicting surgical risks.

Asunto(s)

Neoplasias Renales , Laparoscopía , Humanos , Radio (Anatomía)/patología , Estudios Retrospectivos , Nefrectomía , Neoplasias Renales/cirugía , Neoplasias Renales/patología , Resultado del Tratamiento

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Purpose: The aim of our study is to compare the perioperative, functional, and oncological outcomes of laparoscopic transperitoneal partial nephrectomy (LTPN) and laparoscopic retroperitoneal partial nephrectomy (LRPN) for posterior cT1 renal tumors. Methods: We retrospectively collected data on all patients who consecutively underwent LTPN and LRPN for posterior cT1 renal tumors in three different centers from January 2015 to January 2023. Patients with a single, unilateral, cT1 renal mass, located in the posterior renal surface were included. Patients' data regarding perioperative, functional, and oncological outcomes were collected from medical records and statistically analyzed and compared. Results: A total of 128 patients was obtained, with 53 patients in the LPTN group and 75 patients in the LRPN group. Baseline characteristics were similar. Warm ischemia time (WIT) (18.8 vs. 22.6 min, p = 0.002) and immediate postoperative eGFR drop (-6.1 vs. -13.0 mL/min/1.73 m2, p = 0.047) were significantly lower in the LPTN group. Estimated blood loss (EBL) (100 vs. 150 mL, p = 0.043) was significantly lower in the LRPN group. All other perioperative and functional outcomes and complications were similar between the groups. The positive surgical margin (PSM) rate was lower in the LRPN group, although without statistical significance (7.2% vs. 13.5%, p = 0.258). Surgical success defined by Trifecta (WIT ≤ 25 min, no PSM, and no major postoperative complication) was similar between both approaches. Conclusions: LTPN has significantly shorter WIT and a significantly smaller drop in immediate eGFR when compared to LRPN for posterior renal tumors. On the other hand, LRPN has significantly less EBL than LTPN. LRPN demonstrated fewer PSMs than LTPN, albeit without statistical significance. In terms of overall surgical success, as defined by Trifecta, both approaches achieved similar results.

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Purpose: Laparoscopic partial nephrectomy (LPN) remains the most commonly used measure for treating localized renal cell cancer (RCC) with an increasing incidence of RCC ever since the 1990s. This study aimed to identify risk factors that affect the postoperative time of drainage and total drainage volume after LPN. Method: The clinical data of 612 RCC patients who received LPN from January 2012 to December 2022 in our hospital, including the postoperative drainage time and total drainage volume, were retrospectively analyzed. Univariable and multivariable linear regression and correlation analyses were used to identify the correlations between 21 factors, which include gender, age, history of alcohol consumption, family history of RCC, body weight, body mass index (BMI), and operation time, postoperative drainage time, and total drainage volume. Results: The mean time of drainage was 3.52 ± 0.71 days (range: 2 to 8 days), with an average total drainage volume of 259.83 ± 72.64 mL (range: 50 to 620 mL). Both univariable and multivariable linear regression analyses revealed several statistically significant associations. Gender (p = 0.04), age (p = 0.008), smoking history (p < 0.001), diabetes (p = 0.032), operation time (p = 0.014), and BMI (p = 0.023) were identified as significant factors associated with the time of drainage. On the other hand, age (p = 0.008), smoking history (p < 0.001), diabetes (p = 0.006), and BMI (p = 0.016) emerged as independent risk factors influencing the total drainage volume. Conclusion: The duration of postoperative drainage was found to be associated with gender, age, smoking history, diabetes, operation time, and BMI. In contrast, the total drainage volume was primarily influenced by age, smoking history, diabetes, and high BMI following LPN. For patients with these conditions, meticulous attention to hemostasis and bleeding control is crucial during the perioperative period.

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Background/Aim: Cystic nephroma (CN) is a very rare, benign, renal cystic lesion, which is characterized by a usually unilateral, multicystic kidney mass. In adults it is seen more frequently in females (1:8 male-to-female ratio). The peak incidence of CN is between 50 and 60 years of age. Median age at diagnosis is 55 years for females and 44 years for men and it is a rare entity in adults under 30 years of age. Case Report: We report the case of a 52-year-old female patient with chronic right-flank pain, who was treated at our hospital. A multiloculated 10×8.6 cm Bosniak IV renal cyst tumor was depicted on retroperitoneal computed tomography. After a three-dimensional laparoscopic partial nephrectomy, the histopathological specimen examination revealed: a multilocular cystic nephroma. Conclusion: CNs are rare benign tumors that should be included in the differential diagnosis when treating large multiloculated complex renal cysts.

Asunto(s)

Carcinoma de Células Renales , Riñón Fusionado , Neoplasias Renales , Laparoscopía , Humanos , Carcinoma de Células Renales/cirugía , Riñón Fusionado/complicaciones , Riñón Fusionado/diagnóstico por imagen , Riñón Fusionado/cirugía , Nefrectomía , Neoplasias Renales/cirugía , Neoplasias Renales/patología

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Echinococcus granulosus , Procedimientos Quirúrgicos Robotizados , Robótica , Animales , Humanos , Riñón , Nefrectomía

RESUMEN

INTRODUCTION: During last 20 years in urology there has been a number of significant advancements, which were due to the introduction into practice and improvement of minimally invasive techniques. Development of laparoscopic surgery allowed to actively introduce these procedures in various kidney disorders, including renal tumors. Laparoscopic partial nephrectomy is also undergoing changes in order to improve the technique. Standard technique requires four or more trocars, where fourth (additional) trocar is put for the assistant. However, there is an opinion that in most cases it is possible to perform partial nephrectomy without an assistant trocar, while maintaining the safety and efficiency of the procedure and improving some perioperative outcomes. The aim of our study was to compare the safety and efficiency of the three-trocar and four-trocar techniques during transperitoneal partial nephrectomy. This article also presents the technical features of laparoscopic partial nephrectomy. MATERIALS AND METHODS: Between 2021 and 2023, a total of 200 patients were included in the study comparing three- and four-trocar partial nephrectomy. RESULTS: There was no difference in the rate of achieving renal trifecta between the two groups. In the three-trocar group, 94 cases of renal trifecta were found, while in the four-trocar group, there were 95 patients with renal trifecta. CONCLUSIONS: The three-trocar technique is not inferior in safety and efficiency to the standard four-trocar technique. The main advantages of the three-trocar technique are less pain, cost and post-operative scarring.

Asunto(s)

Neoplasias Renales , Laparoscopía , Humanos , Laparoscopía/métodos , Nefrectomía/métodos , Riñón , Neoplasias Renales/cirugía , Instrumentos Quirúrgicos , Estudios Retrospectivos

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Introduction: Malignancy during pregnancy requires consideration of both the mother and fetus. We report a patient with renal cell carcinoma during pregnancy who was treated with robot-assisted partial nephrectomy. Case presentation: The patient was incidentally found to have a renal mass on abdominal ultrasonography. Definitive diagnosis of cT1aN0M0 RCC was made by enhanced computed tomography. Subsequently, pregnancy was discovered. RAPN was performed without complications. Pathologic examination revealed clear cell RCC. There were no postoperative complications, and the baby was born safely. Conclusion: RAPN can be safe and effective even during pregnancy. Every pregnant patient requires individualized treatment involving the timing of surgery, the procedure used, and management based on the condition of the mother and fetus, tumor stage, and the experience of the surgical team.

RESUMEN

A clinical case of the use of fluorescence imaging in the near infrared spectrum with indocyanine green during laparoscopic right-side partial nephrectomy is presented in the article.

Asunto(s)

Neoplasias Renales , Laparoscopía , Humanos , Verde de Indocianina , Neoplasias Renales/diagnóstico por imagen , Neoplasias Renales/cirugía , Laparoscopía/métodos , Nefrectomía/métodos , Imagen Óptica/métodos