Our laparoscopic radical nephrectomy experiences

Yıl 2014, , 732 - 737, 01.12.2014

Mansur Dağgülli Mehmet Mazhar Utanğaç Yaşar Bozkurt Onur Dede Mehmet Nuri Bodakçi Ahmet Ali Sancaktutar Necmettin Penbegül Namık Kemal Hatipoğlu

https://doi.org/10.5798/diclemedj.0921.2014.04.0508

Cited By: 2

Öz

Objective: In this study our aim is to present outcomes of laparoscopic radical nephrectomy (LRN) we have been applying for the management of renal masses. Methods: We retrospectively examined medical files of 54 cases who underwent LRN in the Urology Clinics of Dicle University between October 2010, and April 2014. Archival files of the patients were retrospectively analyzed as for age, gender, obesity, dimensions, and laterality of renal mass, smoking status, history of hypertension, histopathology results, blood transfusion (if any), hospital stays, peri- and post-operative complications, drain removal times, and method of removal of the nephrectomy material. Results: Our study population (n=54) consisted of 21 male, and 33 female patients with a mean age of 58,8 (29-82) years. Some of them were smoker (n=23), hypertensive (n=15), and obese (n=32) patients. Renal masses with a median diameter of 6.2 cm (4,5-16,5) were localized in the right (n=23) or left (n=31) kidneys. In all cases, transperitoneal approach was preferred. In 3 cases we have to switch to an open surgery. In 8 patients, blood transfusions were required. In 18 patients 4th port was used for the retraction of the liver, while in other cases only 3 ports were used. Median operative time was 115.6 min (75-192). Median hospital stay was 3,9 days (3-16). In one case abundant bleeding occurred because of splenic artery injury. Conclusion: Transperitoneal LRN is a minimally invasive surgical method which can be performed rapidly, and effectively. We think that in procedures performed in compliance with surgical principles, LRN can be realized safely with lower complication rates even by urologists in their initial experiences.

Anahtar Kelimeler

Kidney tumor, Laparoscopic surgery, Radical Nephrectomy

Laparoskopik radikal nefrektomi deneyimlerimiz

Öz

Amaç: Bizim bu çalışmadaki amacımız, 4 yıldan beri kliniğimizde böbrek kitleleri için uyguladığımız laparoskopik radikal nefrektomi (LRN) cerrahisinin sonuçlarını sunmaktır. Yöntemler: Ekim 2010 ve Nisan 2014 tarihleri arasında Dicle Üniversitesi Üroloji kliniğinde LRN uygulanan 54 vakayı geriye dönük olarak inceledik. Hastalar yaş, cinsiyet, lateralite, kitle boyutu, obezite, sigara ve hipertansiyon öyküsü, patoloji sonucu, kan transfüzyonu, operasyon zamanı, hastanede kalış süreleri, peroperatif ve postoperatif komplikasyonlar, dren çekilme zamanı ve nefrektomi materyalinin dışarı alınış biçimi açısından geriye dönük olarak incelendi. Bulgular: 54 hastanın 21\'i erkek ve 33\'ü kadındı. Ortalama hasta yaşı 58,8 (29-82) yıl idi. 23 hastada sigara, 15 hastada HT ve 32 hastada obezite saptandı. 23 olguda renal kitle sol tarafta ve 31\'inde sağ tarafta idi. Ortalama tümör boyutu 6,2 cm (4,5-16,5) idi. Bütün olgularda transperitoneal, yaklaşım tercih edildi. 3 vakada açığa geçilme ihtiyacı duyuldu. 8 hastada kan transfüzyonu ihtiyacı oldu. On sekiz hastada, karaciğer ekartasyonu için 4. port kullanılırken, diğer tüm vakalarda 3 port kullanıldı. Ortalama operasyon süresi 115,6 dk (75-192) idi. Ortalama hastanede kalış süresi 3,9 gün (3-16) idi. 1 olguda splenik arter yaralanmasına bağlı abondan kanama gelişti. Sonuç: Transperitoneal LRN, hızlı ve etkin bir şekilde yapılabilen minimal invaziv bir cerrahi yöntemdir. Laparoskopik cerrahi prensiplere bağlı kalarak yapılan cerrahi işlemlerde başlangıç deneyimlerde bile LRN düşük komplikasyon oranları ile güvenle yapılabilecek bir cerrahi olduğunu düşünmekteyiz.

Anahtar Kelimeler

Böbrek tümörü, laparoskopik cerrahi, radikal nefrektomi

Kaynakça

• Kural AR, Demirkesen O, Önal B, et al. Outcome of neph- ron-sparing surgery: elective versus imperative indications. Urol Int 2003;7:190-196.
• Krebs RK, Andreoni C, Ortiz V. Impact of radical and partial nephrectomy on renal function in patients with renal cancer. Urol Int 2014;92:449-454.
• Boeckmann W, Jakse G. Nierenzellkarzinom In Uro-Onkolo- gie, Herbert Rübbenb Springer-Verlag, 1997;25-55.
• Parkin DM, Pisani P, Ferlay J. Global cancer statistic. Ca J Clin 1999;49:33-64.
• Abbou CC, Cicco A, Gasman D. Retroperitoeal laparoscopic versus open radical nephrectomy. J Urol 1999;161:1776- 1780.
• Portis AJ, Yan Y, Landman J, et al. Long-term follow-up after laparoscopic radical nephrectomy. J Urol 2002;167:1257- 1262.
• Gill IS. Laparoscopic radical nephrectomy for cancer. Urol Clin North Am 2000; 27:707-719.
• Clayman RV, Kavoussi LR, Soper NJ, et al. Laparoscopic nephrectomy: initial case report. J Urol 1991;146:278–282.
• Kubilay inci, Sertaç Yazıcı, Cenk Y. Bilen. Üroonkolojik laparoskopi. Hacettepe Tıp Dergisi 2008;39:199-206.
• Tanaka M, Tokuda N, Koga H, et al. Hand-assisted lapa- roscopic radical nephrectomy for renal carcinoma using a new abdominal wall sealing device. J Urol 2000;164:314.
• Steinberg AP, Finelli A, Desai MM, et al. Laparoscopic radical nephrectomy for large (greater than 7 cm, T2) renal tumors. J Urol 2004;172:2172-2176.
• Cadeddu JA, Ono Y, Clayman RV, et al. Laparoscopic ne- phrectomy for renal cell cancer evaluation of efficacy and safety: A multicenter experience. Urology. 1998; 52: 773- 777.
• Dunn MD, Portis AJ, Shalhav AL, et al. Laparoscopic ver- sus open radical nephrectomy: A 9-year experience. J Urol. 2000; 164: 1153–1159.
• Demir Ö, Öztürk B, Egriboyun S, et al. Kliniğimizde Lapa- roskopik cerrahide ilk deneyimlerimiz ve öğrenme süreci. Dokuz Eylül Tıp Fakültesi Dergisi 2010; 24: 105-112.
• Desai M, Strzempkowski B, Matin SF, et al: Prospec- tive randomized comparison of transperitoneal versus retroperitoneal laparoscopic radical nephrectomy. J Urol 2005;173:38-41.
• Kural AR: Laparoskopik radikal nefrektomi. Üroonkoloji Bülteni 2003;3:9-16.
• Soulie M, Seguin P. Urological complications of laparo- scopic surgery: Experience with 350 procedures at a single center. J Urol 2002;165: 1960-1963.
• Deziel DJ, Millikan KW, Economou SG, et al. Complica- tions of laparoscopic cholecystectomy: a national survey of 4292 hospitals and analysis of 77604 cases. Amer J Surg 1993;165:9-14.
• Meraney AM, Samee AA, Gill IS. Vascular and bowel com- plications during retroperitoneal laparoscopic surgery. J Urol 2002;168:1941-1944.
• Nelson CP, Wolf JS. Comparison of hand assisted versus standard laparoscopic radical nephrectomy for suspected renal cell carcinoma. J Urol 2002;167:1989-1994.
• Alan J. Wein, Louis R. Kavoussi, Andrew C. Novick, et al. Malignant Renal Tumors. Campbell-Walsh Urology, 10th Edn. 2012:1414.
• Ono Y, Kinukawa T. The long term outcome of laparoscopic radical nephrectomy for small renal cell carcinoma. J Urol 2001;165:1867-1870.
• Wolf JS, Marcovich R, Gill IS et al. Survey of neuromuscu- lar injuries to the patient and surgeon during urologic lapa- roscopic surgery. Urology 2000;55:831-836.
• Rassweiler J, Tsivian A, Kumar AVR, et al. Oncologi- cal safety of laparoscopic surgery for urological malig- nancy: experience with more than 1000 operations. J Urol 2003;169: 2072.
• McDougall E, Clayman RV, Elashry OM. Laparoscopic radical nephrectomy for renal tumor: the Washington Uni- versity experience. J Urol 1996;155:1180-1185.
• Allan JD, Tolley DA, Kaouk JH, et al. Laparoscopic radical nephrectomy. Eur Urol 2001;40:17-23.
• Hatipoğlu NK, Penbegül N, Söylemez H, et al. Urological laparoscopic surgery: Our experience of first 100 cases in Dicle University. J Clin Exp Invest 2012;3:44-48.