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PURPOSE: To describe the perioperative and oncology outcomes in a series of laparoscopic or robotic partial nephrectomies (PN) for renal tumors treated in diverse institutions of Hispanic America from the beginning of their minimally invasive (MI) PN experience through December 2014. METHODS: Seventeen institutions participated in the CAU generated a MI PN database. We estimated proportions, medians, 95 % confidence intervals, Kaplan-Meier curves, multivariate logistic and Cox regression analyses. Clavien-Dindo classification was used. RESULTS: We evaluated 1501 laparoscopic (98 %) or robotic (2 %) PNs. Median age: 58 years. Median surgical time, warm ischemia and intraoperative bleeding were 150, 20 min and 200 cc. 81 % of the lesions were malignant, with clear cell histology being 65 % of the total. Median maximum tumor diameter is 2.7 cm, positive margin is 8.2 %, and median hospitalization is 3 days. One or more postoperative complication was recorded in 19.8 % of the patients: Clavien 1: 5.6 %; Clavien 2: 8.4 %; Clavien 3A: 1.5 %; Clavien 3B: 3.2 %; Clavien 4A: 1 %; Clavien 4B: 0.1 %; Clavien 5: 0 %. Bleeding was the main cause of a reoperation (5.5 %), conversion to radical nephrectomy (3 %) or open partial nephrectomy (6 %). Transfusion rate is 10 %. In multivariate analysis, RENAL nephrometry score was the only variable associated with complications (OR 1.1; 95 % CI 1.02-1.2; p = 0.02). Nineteen patients presented disease progression or died of disease in a median follow-up of 1.37 years. The 5-year progression or kidney cancer mortality-free rate was 94 % (95 % CI 90, 97). Positive margins (HR 4.98; 95 % CI 1.3-19; p = 0.02) and females (HR 5.6; 95 % CI 1.7-19; p = 0.005) were associated with disease progression or kidney cancer mortality after adjusting for maximum tumor diameter. CONCLUSION: Laparoscopic PN in these centers of Hispanic America seem to have acceptable perioperative complications and short-term oncologic outcomes.
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Adenoma Oxifílico/cirugía , Angiomiolipoma/cirugía , Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Nefrectomía/métodos , Complicaciones Posoperatorias/epidemiología , Adenoma Oxifílico/patología , Anciano , Angiomiolipoma/patología , Pérdida de Sangre Quirúrgica , Carcinoma de Células Renales/patología , Conversión a Cirugía Abierta , Bases de Datos Factuales , Femenino , Laparoscópía Mano-Asistida/métodos , Humanos , Estimación de Kaplan-Meier , Neoplasias Renales/patología , Laparoscopía/métodos , Tiempo de Internación/estadística & datos numéricos , Modelos Logísticos , Masculino , Márgenes de Escisión , México , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Análisis Multivariante , Estadificación de Neoplasias , Tempo Operativo , Modelos de Riesgos Proporcionales , Procedimientos Quirúrgicos Robotizados/métodos , América del Sur , España , Carga Tumoral , Isquemia TibiaRESUMEN
INTRODUCTION: The live donor nephrectomy is an unusual surgical procedure as it is performed on healthy individuals. It is important to make the procedure as safe as possible without compromising the health of the donor and graft function. JUSTIFICATION: In Mexico during 2014, 2610 kidney transplantations performed, and 1862 grafts were from living donors. OBJECTIVE: We describe our experience with hand-assisted laparoscopic nephrectomy on live donors for kidney transplantation. MATERIALS AND METHODS: We present a descriptive and observational study in which all living donors who completed the study protocol for renal transplantation are included. RESULTS: From September 2006 to July 2015, there were 238 hand-assisted laparoscopic nephrectomies with live donors; 227 (95.37%) were performed on the left side and 11 (4.63%) on the right side. Of donors, 54.1% were females. The average values for the variables analyzed were age 38.17 years, 25.94 BMI, creatinine 0.82-1.13 mg/dL pre- and postoperative month respectively, length of stay 4.95 (range 2-8), warm ischemia 5.07 (range 3-13) minutes, surgical time 168.85 minutes (range 90-306), and transsurgical bleeding 139 055 mL (range 25-650). One patient was reoperated for abdominal pain and bloating without evidence of pathology, attributing it to metabolic ileus. Two patients were converted to open surgery; 1 by technical problems with the laparoscopic equipment and the second by bleeding from the renal vein, both with good results. DISCUSSION AND CONCLUSIONS: Laparoscopic nephrectomy is a safe method that allows kidney donors to have a speedy recovery without modifying the survivals of renal grafts.
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Laparoscópía Mano-Asistida/métodos , Trasplante de Riñón/métodos , Donadores Vivos , Nefrectomía/métodos , Recolección de Tejidos y Órganos/métodos , Adulto , Anciano , Femenino , Humanos , Laparoscopía/métodos , Masculino , México , Persona de Mediana Edad , Tempo OperativoRESUMEN
PURPOSES: To evaluate in an animal model the feasibility of a novel concept of hand-assisted surgery consisting of inserting two hands into the abdomen instead of one. The chosen procedure was retroperitoneal lymph node dissection (L-RPLND) that was performed in five pigs. SURGICAL TECHNIQUE: A Pfannestiel and a transverse epigastric incisions were made through which both hands were introduced. The scope was inserted through the umbilicus. The colon was moved medially and the dissection was performed as in open surgery using short conventional surgical instruments. COMMENTS: The surgery was fulfilled easily and safely in quite a similar way as in open surgery. Two-handed laparoscopy may be indicated in cases that still today require an open approach as apparently makes the operation easier and significantly shortens the surgery time. However, new opinions and trials are required.
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Laparoscópía Mano-Asistida/métodos , Riñón/cirugía , Escisión del Ganglio Linfático/métodos , Modelos Animales , Animales , Estudios de Factibilidad , Masculino , Ilustración Médica , Peritoneo/cirugía , Reproducibilidad de los Resultados , Espacio Retroperitoneal/cirugía , PorcinosRESUMEN
Purposes To evaluate in an animal model the feasibility of a novel concept of hand-assisted surgery consisting of inserting two hands into the abdomen instead of one. The chosen procedure was retroperitoneal lymph node dissection (L-RPLND) that was performed in five pigs. Surgical Technique A Pfannestiel and a transverse epigastric incisions were made through which both hands were introduced. The scope was inserted through the umbilicus. The colon was moved medially and the dissection was performed as in open surgery using short conventional surgical instruments. Comments The surgery was fulfilled easily and safely in quite a similar way as in open surgery. Two-handed laparoscopy may be indicated in cases that still today require an open approach as apparently makes the operation easier and significantly shortens the surgery time. However, new opinions and trials are required. .
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Animales , Masculino , Laparoscópía Mano-Asistida/métodos , Riñón/cirugía , Escisión del Ganglio Linfático/métodos , Modelos Animales , Estudios de Factibilidad , Ilustración Médica , Peritoneo/cirugía , Reproducibilidad de los Resultados , Espacio Retroperitoneal/cirugía , PorcinosRESUMEN
Excision of renal cell carcinoma (RCC) with corresponding vena cava thrombus is a technical challenge requiring open resection and vascular clamping. A 58 year old male with a right kidney tumor presented with a thrombus extending 1 cm into the vena cava. Using a hand-assisted transperitoneal approach through a 7 cm gel-port, the right kidney was dissected and the multiple vascular collaterals supplying the tumor were identified and isolated. The inferior vena cava was mobilized 4 cm cephalad and 4 cm caudal to the right renal vein. Lateral manual traction was applied to the right kidney allowing the tumor thrombus to be retracted into the renal vein, clear of the vena cava. After laparoscopic ultrasonographic confirmation of the location of the tip of the tumor thrombus, an articulating laparoscopic vascular stapler was used to staple the vena cava at the ostium of the right renal vein. This allowed removal of the tumor thrombus without the need for a Satinsky clamp. The surgery was completed in 243 minutes with no intra-operative complications. The entire kidney and tumor thrombus was removed with negative surgical margins. Estimated blood loss was 300 cc. We present a laparoscopic resection of a renal mass with associated level II thrombus using a hand-assisted approach. In patients with minimal caval involvement, our surgical approach presents an option to the traditional open resection of a renal mass.
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Carcinoma de Células Renales/cirugía , Laparoscópía Mano-Asistida/métodos , Neoplasias Renales/cirugía , Nefrectomía/métodos , Trombosis/cirugía , Vena Cava Inferior/cirugía , Humanos , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Nefrectomía/instrumentación , Venas Renales/cirugía , Trombosis/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
Excision of renal cell carcinoma (RCC) with corresponding vena cava thrombus is a technical challenge requiring open resection and vascular clamping. A 58 year old male with a right kidney tumor presented with a thrombus extending 1 cm into the vena cava. Using a hand-assisted transperitoneal approach through a 7 cm gel-port, the right kidney was dissected and the multiple vascular collaterals supplying the tumor were identified and isolated. The inferior vena cava was mobilized 4 cm cephalad and 4 cm caudal to the right renal vein. Lateral manual traction was applied to the right kidney allowing the tumor thrombus to be retracted into the renal vein, clear of the vena cava. After laparoscopic ultrasonographic confirmation of the location of the tip of the tumor thrombus, an articulating laparoscopic vascular stapler was used to staple the vena cava at the ostium of the right renal vein. This allowed removal of the tumor thrombus without the need for a Satinsky clamp. The surgery was completed in 243 minutes with no intra-operative complications. The entire kidney and tumor thrombus was removed with negative surgical margins. Estimated blood loss was 300 cc. We present a laparoscopic resection of a renal mass with associated level II thrombus using a hand-assisted approach. In patients with minimal caval involvement, our surgical approach presents an option to the traditional open resection of a renal mass.