Renal Sparing Surgery Using Focus Ultracision Harmonic Scalpel in Patients with Bilateral Wilms’ Tumor: Case Report

Abstract

Background: Bilateral Wilms' tumor is rare and surgical treatment requires an individual approach. Surgical approach to the tumors located in the central part of the kidney represents a major challenge and nephrectomy is usually essential. Renal sparing surgery is difficult in such cases. Case Report: We describe a 3 year-old female patient with bilateral Wilms' tumor arising in the central localisation of the right and foci in the left kidney enucleated successfully with a simple and comfortable renal preserving operative technique using Focus Ultracision Harmonic Scalpel. Conclusion: In cases when tumors are located in the central part of the kidney and partial nephrectomy is consequently very difficult, the use of a Focus Ultracision Harmonic Scalpel provides easy dissecting, enucleation, and excision of the tumor. Turkish Başlık: Bir Santral Yerleşimli Bilateral Wilms Tümöründe “Focus Harmonic Scalpel” Kullanılarak Böbrek Koruyucu Cerrahi: Ameliyat Tekniği Anahtar Kelimeler: Bilateral Wilms tümörü, böbrek koruyucu, harmonic Arkaplan: Bilateral Wilms tümörü nadirdir ve tedavisinde hastaya özel yaklaşım gerektirir. Özellikle böbreğin orta kısmında yerleşim gösteren tümörlere cerrahi yaklaşım ciddi zorluklar ortaya koyar. Bu tür olgularda böbrek koruyucu cerrahinin uygulanması zordur ve genellikle nefrektomi yapılması gerekir. Olgu Sunumu: Bu çalışmada, sağ böbrekte orta yerleşimli ve solda küçük bir odağın olduğu bilateral Wilms tümörlü 3 yaşında bir kız olguda “Focus Harmonic Scalpel” kullanarak kolayca ve başarı ile böbrek koruyucu cerrahi ile tümörlerin çıkarılışı tanımlanmıştır. Sonuç: Böbrek koruyucu cerrahinin mümkün olmadığı, orta yerleşimli bilateral Wilms tümörlü hastalarda “Focus Harmonic Scalpel” kullanılarak tümörün diseksiyonu veya enükleasyonu kolaylıkla sağlanabilir.

Keywords

• Bilateral Wilms’ tumor, renal sparing, harmonic

Renal Sparing Surgery Using Focus Ultracision Harmonic Scalpel in Patients with Bilateral Wilms’ Tumor: Case Report

Öz

References

1. Young JL Jr, Heise HW, Silverberg E, Myers Mh. Cancer incidence, survival and mortality for children under 15 years of age. American Cancer Society Professional Education Publication, New York, September 1978
2. Montgomery BT, Kelalis PP, Blute ML, Bergstralh EJ, Beckwith JB, Norkool P, et al. Extended follow-up of bilateral Wilms tumor: results of National Wilms Tumor Study. J Urol 1991;146:514-18. Cooper CS, Jaffe WI, Huff DS, Canning DA, Zderic SA, Meadows AT, et al. The role of renal salvage procedures for bilateral Wilms tumor: a 15-year review. J Urol 2000;163:265-8. [CrossRef]
3. Davidoff AM, Giel DW, Jones DP, Jenkins JJ, Krasin MJ, Hoffer FA, et al. The feasibility and outcome of nephron- sparing surgery for children with bilateral Wilms tumor. Cancer 2008; 112: 2060-70. [CrossRef]
4. Ecker T, Carvalho AL, Choe JH, Walosek G, Preuss KJ. Hemostasis in thyroid surgery: harmonic scalpel versus other techniques-a meta-analysis. Otolaryngol Head Neck Surg 2010;143:17-25. [CrossRef]
5. Westervelt J. Clipless cholecystectomy: broadening the role of the harmonic scalpel. JSLS 2004;8:283-5.