Commentary
Comment to: “Combined Approach of Laparoscopic and Open Surgery for Complex Renal Lesions”
Comentario editorial a: «Abordaje combinado para la nefrectomía parcial en lesiones renales complejas»
C. Núñez
Servicio de Urología, MD Anderson Cancer Center Madrid, Madrid, Spain
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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" => "<span class="elsevierStyleTextfn">Commentary</span>" "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" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Currently, laparoscopic partial nephrectomy (LPN) is the technique of choice for the treatment of renal tumors smaller than 4<span class="elsevierStyleHsp" style=""></span>cm (T1a) and for selected bigger tumors (T1b), particularly those of polar location.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The LPN makes it possible to treat tumors of any location,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></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.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Palou et al.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></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 13<span class="elsevierStyleHsp" style=""></span>min. This type of combined approach was already presented by Lu et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> in 6 cases of posterior valve renal tumors, combining retroperitoneoscopy and lumbotomy, referring a mean warm ischemia time of 23<span class="elsevierStyleHsp" style=""></span>min. 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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">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.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">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.</p>" ] ] "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." "fecha" => "2013" "volumen" => "37" "paginaInicial" => "120" "paginaFinal" => "126" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Laparoscopic-assisted partial nephrectomy combined with open procedure for posteromedial renal tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.S. Lu" 1 => "X. Zhang" 2 => "J.P. Gao" 3 => "L. Zhang" 4 => "Q. 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" ]
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