Comment to: “Combined Approach of Laparoscopic and Open Surgery for Complex Renal Lesions”

Núñez, C.

doi:10.1016/j.acuroe.2012.10.001

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Palou, M. Oliveira, P. Pardo, J.A. Peña, O. Rodríguez, A. Rosales, H. Villavicencio" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Palou" ] 1 => array:2 [ "nombre" => "M." "apellidos" => "Oliveira" ] 2 => array:2 [ "nombre" => "P." "apellidos" => "Pardo" ] 3 => array:2 [ "nombre" => "J.A." "apellidos" => "Peña" ] 4 => array:2 [ "nombre" => "O." "apellidos" => "Rodríguez" ] 5 => array:2 [ "nombre" => "A." "apellidos" => "Rosales" ] 6 => array:2 [ "nombre" => "H." "apellidos" => "Villavicencio" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210480612002471" "doi" => "10.1016/j.acuro.2012.06.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210480612002471?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578613000553?idApp=UINPBA00004N" "url" => "/21735786/0000003700000002/v1_201306251140/S2173578613000553/v1_201306251140/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Commentary" "titulo" => "Comment to: “Combined Approach of Laparoscopic and Open Surgery for Complex Renal Lesions”" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "127" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "C. Núñez" "autores" => array:1 [ 0 => array:3 [ "nombre" => "C." "apellidos" => "Núñez" "email" => array:1 [ 0 => "cnunez@mdanderson.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Servicio de Urología, MD Anderson Cancer Center Madrid, Madrid, Spain" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Comentario editorial a: «Abordaje combinado para la nefrectomía parcial en lesiones renales complejas»" ] ] "textoCompleto" => "Currently, laparoscopic partial nephrectomy (LPN) is the technique of choice for the treatment of renal tumors smaller than 4cm (T1a) and for selected bigger tumors (T1b), particularly those of polar location.The LPN makes it possible to treat tumors of any location,<a class="elsevierStyleCrossRef" href="#bib0005">1</a> including tumors of hilar, central location or with urinary tract involvement, although the laparoscopic approach of the most complex cases is only available to highly experienced surgeons. This is because, in these cases, the technical difficulty can produce increased warm ischemia time with possible permanent kidney damage.Palou et al.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> present an initial study on 6 patients who undergo a combined approach, laparoscopic and through subcostal minilaparotomy, to conduct partial nephrectomy in complex tumors while maintaining reduced warm ischemia times, around 13min. This type of combined approach was already presented by Lu et al.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> in 6 cases of posterior valve renal tumors, combining retroperitoneoscopy and lumbotomy, referring a mean warm ischemia time of 23min. This ischemia time is much higher than that reported by Palou et al. This is probably due to the reduced renal mobility obtained by retroperitoneoscopy versus the transperitoneal approach.The application of combined approaches in LPN can be a useful resource in the cases of complex tumors in which it is expected that pure laparoscopic surgery can prolong excessively the warm ischemia time, enabling surgery by minilaparotomy with an expected better recovery than with a classical lumbotomy. Despite this, we should not forget that the combined approach will mean a loss, at least partial, of the benefits of pure laparoscopy (smaller incision, greater flow with reduced analgesic need), and that in the most complex cases (hilar, central, or polar T1b tumors) we tend to perform LPN with ‘zero ischemia’ by intrasinusal vascular dissection, so the advantages of the combined approach disappear in these cases." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Núñez C. Comentario editorial a “Abordaje combinado para la nefrectomía parcial en lesiones renales complejas”. Actas Urol Esp. 2013;37:127." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A critical analysis of the actual role of minimally invasive surgery and active surveillance for kidney cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Heuer" 1 => "I.S. Gill" 2 => "G. Guazzoni" 3 => "Z. Kirkali" 4 => "M. Marberger" 5 => "J.P. Richie" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eururo.2009.10.023" "Revista" => array:6 [ "tituloSerie" => "Eur Urol." "fecha" => "2010" "volumen" => "57" "paginaInicial" => "223" "paginaFinal" => "232" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19853989" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Abordaje combinado para la nefrectomía parcial en lesions renales complejasá" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Palou" 1 => "M. Oliviera" 2 => "P. Pardo" 3 => "J.A. Peña" 4 => "O. Rodríguez" 5 => "A. Rosales" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Actas Esp Urol." 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Zu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.urology.2010.02.059" "Revista" => array:6 [ "tituloSerie" => "Urology" "fecha" => "2010" "volumen" => "76" "paginaInicial" => "1414" "paginaFinal" => "1418" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20546872" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735786/0000003700000002/v1_201306251140/S2173578613000565/v1_201306251140/en/main.assets" "Apartado" => array:4 [ "identificador" => "13765" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Surgical techniques" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735786/0000003700000002/v1_201306251140/S2173578613000565/v1_201306251140/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173578613000565?idApp=UINPBA00004N"]

ISSN: 2173-5786

Actas Urológicas Españolas is an international journal dedicated to urological diseases and renal transplant. It has been the official publication of the Spanish Urology Association since 1974 and of the American Urology Confederation since 2008. Its articles cover all aspects related to urology. Actas Urológicas Españolas, governed by the peer review system (double blinded), is published online in Spanish and English. Consequently, manuscripts may be sent in Spanish or English and bidirectional free cost translation will be provided. It has high visibility and accessibility and is found in the most important data bases, Medline/Pubmed, Emabase, JCR, Ïndice Médico Español, Índice bibliográfico Español en Ciencias de la Salud (IBECS), Cuiden, Dialnet, Hinari, Scopus, Google Scholar.

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Vol. 37. Issue 2.

Pages 127 (February 2013)

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