An Easy and Effective Method to Locate Renal Vein During Retroperitoneal Laparoscopic Radical Nephrectomy: Single-Center Experience

Luo, Lei; Liu, Yanan; Zhang, Yan; Zhang, Guiming; Sun, Lili; Liu, Yong; Wang, Fang‐Ming

doi:10.12659/msm.911199

Cited by 7 publications

(6 citation statements)

References 12 publications

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“…RLRN has smaller surgical incision, less postoperative pain, and less impact on gastrointestinal function of patients, which can help patients recover gastrointestinal function at an early stage, shorten postoperative feeding time of patients, and enable patients to get out of bed and exercise as soon as possible. Moreover, RLRN has less trauma, clear surgical approach, no need for incision of the peritoneum, and less separated abdominal tissues, which can avoid long-term exposure of abdominal organs, effectively improve the injury and pollution of other abdominal organs, and contribute to postoperative recovery [ 26 , 27 ]. The results of this study showed that the total incidence of postoperative complications in the observation group was lower than that in the control group, and the levels of serum IL-6 and TNF- α were lower than those in the control group.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effect of Retroperitoneal Laparoscopic Radical Nephrectomy on Renal Cell Carcinoma, the Influence of Renal Function, and the Influencing Factors of Recurrence

Pei

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Renal cell carcinoma is abbreviated as renal carcinoma, and its clinical symptoms are basically hematuria, lumbago, and abdomen bump. As people’s lifestyles change, the incidence of renal carcinoma continues to rise due to factors such as smoking and obesity. At present, surgical treatment is mostly used in clinical practice. Traditional open radical nephrectomy (ORN) is one of the main methods for clinical treatment of renal carcinoma. However, due to its large wound and large amount of intraoperative blood loss, the renal function of patients after surgery is poor, which is not conducive to the postoperative recovery of patients. Retroperitoneal laparoscopic radical nephrectomy (RLRN) has been widely used in the surgical treatment of renal cancer due to its advantages of small wound, less bleeding, and rapid recovery. The purpose of this study was to investigate the efficacy of RLRN in the treatment of renal cancer patients and its effect on renal function and to analyze the related factors affecting postoperative recurrence of patients. We adopt ORN and RLRN, two kinds of treatment, in patients with renal cancer surgery way, contrast analysis of the two groups of operation time, intraoperative blood loss, postoperative intestinal function recovery time, drainage tube indwelling time, length of hospital stay, and other clinical indicators and renal function indexes and use the single factor analysis and multifactor analysis, the relevant factors that affect kidney cancer patients with postoperative recurrence. The results showed that, compared with ORN treatment, RLRN treatment of renal cancer patients has a short operation time, less trauma, quick recovery after surgery, and fewer complications and can effectively alleviate the renal function injury and the body’s inflammatory response, which is worthy of promotion. Postoperative recurrence was related to age, tumor diameter, TNM stage, surgical method, and postoperative immunotherapy.

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Section: Discussionmentioning

confidence: 99%

Clinical Effect of Retroperitoneal Laparoscopic Radical Nephrectomy on Renal Cell Carcinoma, the Influence of Renal Function, and the Influencing Factors of Recurrence

Pei

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…However, the urologists often consider the medial arcuate ligament as a landmark for dissecting the renal artery during the nephrectomy and the procedure often does damage to the transversalis fascia. 12 , 13 It may lead to the failure of LA spread into the subendothoracic compartment after the transmuscular or subcostal QL block. Our group has recently proposed this problem.…”

Section: Discussionmentioning

confidence: 99%

“…6,7,[9][10][11] Interestingly, the medial arcuate ligament (MAL) serves as a critical anatomic landmark for urologists in renal artery dissection during laparoscopic nephrectomy. 12,13 Therefore, the transversalis fascia is possibly disrupted during the renal artery dissection, since the posterior renal fascia fuses with transversalis fascia. [14][15][16] The disruption of the integrity of transversalis fascia can affect the blocking efficacy of anterior QL blocks due to LA leak.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Sensory Loss and Postoperative Analgesia Obtained by Diaphragmatic Apposition Zone Block Under Direct Laparoscopic Visualization in Patients Undergoing Nephrectomy: A Descriptive Study

Shi¹,

Wang²,

Yang³

et al. 2022

JPR

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Purpose Local anesthetics can spread into the subendothoracic fascia compartment via the arcuate ligament and apposition zone of the diaphragm after the anterior quadratus lumborum blocks. Therefore, a new block may be achieved if local anesthetic is administered into the diaphragmatic apposition zone (DAZ) under direct laparoscopic visualization by surgeons. Therefore, we evaluated the sensory loss and postoperative analgesic efficacy of this new block in patients receiving laparoscopic nephrectomy. Methods A total of 28 patients scheduled to receive elective laparoscopic nephrectomy under general anesthesia were enrolled in this study. The DAZ blocks were performed in patients under direct laparoscopic visualization with 20 mL of 0.5% ropivacaine before the dissected kidneys or renal tumors were taken out from the incision. All patients received the intravenous patient-controlled analgesia after surgery. The dermatomes of sensory loss and the muscle weakness of quadriceps femoris were assessed at 2 h post-surgery in the wards. The postoperative pain was scored. The opioid consumption in the first 24 h after surgery was recorded. Results The average number of dermatomes of sensory block was 8.6 ± 1.2. The highest level of sensory loss was T6 (T5-T6) [median (interquartile range, IQR)], and the lowest level of sensory block was L1 (L1–L2). The postoperative pain scores at rest or on movement at 2 h, 6 h, 12 h, 24 h and 48 h were kept at the low levels (less than 4). The muscle strength of the quadriceps femoris evaluated was 5 (5–5) points [median (IQR)]. Total dose of intravenous morphine equivalent consumption in the first 24 h after surgery was 21.2 ± 4.1 mg. Conclusion The DAZ block manifests a wide dermatomal coverage of sensory loss and is associated with the low levels of postoperative pain intensity and opioid use. It provides a new postoperative analgesia option for patients undergoing laparoscopic nephrectomy.

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“…After finding the renal artery and clamping it with Hem-o-lok, the safety of the operation is largely guaranteed, and the surgeon will become much calmer when he or she handles the renal vein. Previous retroperitoneal techniques usually dissected, ligated, and divided renal vessels after the entire mobilization of the kidney (dorsal and abdominal side, lateral and medial side, upper and lower pole) [18, 19]. The renal pedicle was usually located mainly through landmarks, including the psoas muscle, the median arcuate ligament, and the diaphragm [20].…”

Section: Discussionmentioning

confidence: 99%

The methods and techniques of identifying renal pedicle vessels during retroperitoneal laparoscopic radical and partial nephrectomy

Yang

Zhou

et al. 2019

World J Surg Onc

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Background Retroperitoneal laparoscopic radical and partial nephrectomy (RLRN and RLPN) have become the preferred modes of management for renal malignancy. One of the most critical steps in the RLRN and RLPN process is to seek and control the renal pedicle. The current study focuses on introducing methods and techniques that can help quickly and accurately identify the renal pedicle vessels during RLRN and RLPN. Methods RLRNs and RLPNs were performed for 292 cases in our hospital from November 2014 to January 2017. Different measures were adopted to seek and manage bilateral renal pedicle vessels. All operation procedures were performed by the following three steps: dissection, opening, and clamping. For the left lateral, after the perirenal fat in the dorsal and lateral side was fully dissected, the kidney was pushed toward the ventral side. The renal artery was visible when opening the dense bulging connective tissue, which was located in the middle of the dorsal interior of the kidney. Then, the renal artery was clamped with a Hem-o-lok or the Bulldog clamp. For the right kidney pedicles, the inferior vena cava was first identified and then dissipated upward. When the inferior vena cava was not visible, it was often the location of the right renal artery. The treatment for the artery was the same as for the left renal artery. Relevant clinical characteristics of patients, such as operative time, intraoperative blood loss, and duration of postoperative drainage, were analyzed retrospectively. The three-step method of identifying renal pedicle vessels during retroperitoneal laparoscopic radical and partial nephrectomy was evaluated. Results All operations were successfully accomplished with satisfying results, during which the artery could be controlled quickly, and no cases were converted to open surgery due to severe bleeding of renal pedicle vessels. There were no complications involving renal vessels during the entire study. The mean operative times were (81.9 ± 19.71) min and (88.2 ± 21.28) min for RLRN and RLPN, with an average intraoperative blood loss of (91.7 ± 47.10) ml and (62.4 ± 47.45) ml, respectively. The warm ischemia time for RLPN was (19.3 ± 5.6) min. The postoperative drainage-tube was removed within (4.5 ± 1.29) d (RLRN) and (4.6 ± 1.98) d (RLPN); the mean postoperative hospital stay times were (7.0 ± 2.4) d and (5.9 ± 1.98) d, respectively. Conclusion The three-step method of identifying renal pedicle vessels during RLRN and RLPN is direct and feasible, and it may help simplify the operating procedure and improve the safety of the surgery. It may be of great practical application value in the clinical field. Electronic supplementary material The online version of this article (10.1186/s12957-019-1580-1) contains supplementary material, which is available to authorized users.

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An Easy and Effective Method to Locate Renal Vein During Retroperitoneal Laparoscopic Radical Nephrectomy: Single-Center Experience

Cited by 7 publications

References 12 publications

Clinical Effect of Retroperitoneal Laparoscopic Radical Nephrectomy on Renal Cell Carcinoma, the Influence of Renal Function, and the Influencing Factors of Recurrence

Clinical Effect of Retroperitoneal Laparoscopic Radical Nephrectomy on Renal Cell Carcinoma, the Influence of Renal Function, and the Influencing Factors of Recurrence

Evaluation of Sensory Loss and Postoperative Analgesia Obtained by Diaphragmatic Apposition Zone Block Under Direct Laparoscopic Visualization in Patients Undergoing Nephrectomy: A Descriptive Study

The methods and techniques of identifying renal pedicle vessels during retroperitoneal laparoscopic radical and partial nephrectomy

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