metricas
covid
Buscar en
Actas Urológicas Españolas (English Edition)
Toda la web
Inicio Actas Urológicas Españolas (English Edition) Combined approach of laparoscopic and open surgery for complex renal lesions
Journal Information
Vol. 37. Issue 2.
Pages 120-126 (February 2013)
Share
Share
Download PDF
More article options
Visits
1119
Vol. 37. Issue 2.
Pages 120-126 (February 2013)
Surgical Technique
Combined approach of laparoscopic and open surgery for complex renal lesions
Abordaje combinado para la nefrectomía parcial en lesiones renales complejas
Visits
1119
J. Palou
Corresponding author
jpalou@fundacio-puigvert.es

Corresponding author.
, M. Oliveira, P. Pardo, J.A. Peña, O. Rodríguez, A. Rosales, H. Villavicencio
Servicio de Urología, Fundació Puigvert, Barcelona, Spain
This item has received
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (2)
Tables (3)
Table 1. Characteristics of the patients, surgical data, and results.
Table 2. Comparison of series.
Table 3. Location of tumor mass.
Show moreShow less
Additional material (1)
Abstract
Objective

To develop a combined surgical approach (laparoscopic and open) that allows an increased vascular control and decreased ischemia time, maintaining the advantages of pure laparoscopic partial nephrectomy (LPN).

Material and methods

During the laparoscopic phase, dissection of the kidney and its pedicle is achieved. Then, an open approach is initiated through a mini-laparotomy, with the kidney being brought to the incision, improving the identification and exposition of the tumors. Following tumor identification by ultrasound, exeresis of the lesion is performed with or without vascular clamping.

Results

Through this approach we performed the excision of complex lesions in 6 patients. Mean surgical time was 192min (range 180–210) and mean warm ischemia time was 13min (0–22), with a mean blood loss of 267ml (100–500). Average pre and postoperative glomerular filtration rate was 51.5 (28–90) and 48.8ml/min/1.73m2 (19–90), respectively. In one patient, suture repair of the pelvicaliceal system was needed, with no other perioperative morbidities being reported.

Conclusions

This combined approach is a minimally invasive surgical alternative, reproducible and safe which preserves the virtues of pure LPN. It allows a better control of the vascular pedicle, reducing the risk of hemorrhage and the warm ischemia time. This technique may be either considered in the treatment of renal masses with indication for partial nephrectomy but of complex laparoscopic approach or as a surgical approach in the early learning curve of the LPN.

Keywords:
Laparoscopy
Nephrectomy
Nephron-sparing surgery
Resumen
Objetivo

Desarrollar un abordaje quirúrgico combinado (laparoscópico y abierto) que permita un mayor control vascular y un menor tiempo de isquemia, conservando las ventajas de la nefrectomía parcial laparoscópica pura (NPL).

Material y métodos

Durante la fase laparoscópica se diseca el riñón y su pedículo. Luego se inicia el abordaje abierto mediante mini-laparotomía permitiendo llevar al riñón a la superficie cutánea, facilitando así una mejor identificación y exposición de las lesiones tumorales. Una vez identificado el tumor por ecografía intraoperatoria se procede, con o sin pinzamiento vascular, a la exéresis de la masa tumoral.

Resultados

Con esta técnica se extrajeron lesiones tumorales complejas en 6 pacientes. La duración media de la intervención fue de 192min (rango: 180-210) y el tiempo medio de isquemia caliente fue de 13min (0-22), con un sangrado medio de 267ml (100-500). La tasa de filtración glomerular pre y postoperatoria media fue 51,5 (28-90) y 48,8ml/min/1,73 m2 (19-90), respectivamente. En un caso se produjo lesión de vía que se corrigió intraoperatoriamente; no se observaron otras morbilidades perioperatorias.

Conclusiones

El abordaje combinado es una alternativa quirúrgica poco invasiva, reproducible y segura que conserva las ventajas de la NPL pura. Permite un mejor control del pedículo vascular disminuyendo el riesgo de sangrado y el tiempo de isquemia caliente. Esta técnica puede ser considerada en masas renales con indicación de nefrectomía parcial de abordaje laparoscópico complejo, o como abordaje quirúrgico en los inicios de la curva de aprendizaje de la NPL.

Palabras clave:
Laparoscopia
Nefrectomía
Cirugía conservadora de nefronas

Article

These are the options to access the full texts of the publication Actas Urológicas Españolas (English Edition)
Subscriber
Subscriber

If you already have your login data, please click here .

If you have forgotten your password you can you can recover it by clicking here and selecting the option “I have forgotten my password”
Subscribe
Subscribe to

Actas Urológicas Españolas (English Edition)

Purchase
Purchase article

Purchasing article the PDF version will be downloaded

Price 19.34 €

Purchase now
Contact
Phone for subscriptions and reporting of errors
From Monday to Friday from 9 a.m. to 6 p.m. (GMT + 1) except for the months of July and August which will be from 9 a.m. to 3 p.m.
Calls from Spain
932 415 960
Calls from outside Spain
+34 932 415 960
E-mail
Article options
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos