Laparoscopic ultrasonography: The wave of the future in renal cell carcinoma?

Abstract

Laparoscopic or robotic surgery is the main method of treating renal cell carcinoma (RCC). Laparoscopic surgery can accurately target lesions and shorten patient recovery time. Renal endogenous tumors or inferior vena cava tumor thrombi are very difficult to remove using the laparoscopic approach. The emergence of laparoscopic ultrasonography (LUS) has solved this problem. LUS can assist in the detection of tumor boundaries and the extent of tumor thrombi. The lack of tactile feedback may hinder the development of laparoscopic surgery for the treatment of renal cancer. LUS has become an important tool that has improved the rates of successful surgery. LUS is applied in not only early and locally advanced RCC treatment but also in monitoring ablation therapy, testing renal blood perfusion, and exposing renal pedicles. Sonographic techniques used for LUS include initial B-mode, Doppler, and contrast-enhanced ultrasound (CEUS). Contrast agents applied for CEUS do not induce nephrotoxicity and can display renal perfusion more accurately than the regular color Doppler ultrasound. According to current literature, LUS is a promising technique for the treatment of RCC, especially for endogenous RCC or RCC with thrombosis, and for monitoring the effectiveness of radiofrequency ablation, although further well-designed studies are warranted.

Intraoperative Ultrasound in Minimally Invasive Laparoscopic and Robotic Pediatric Surgery: Our Experiences and Literature Review

“…In adults, laparoscopic US is used daily to detect liver lesions and to guide biopsy and ablation procedures. Various applications of LICU in urological surgery are described in the literature [11][12][13][14][15][16]. Liu et al applied laparoscopic US in renal cell carcinoma surgery, showing an important role of LICU in improving the accuracy of tumor identification, resection and mapping of renal blood vessels, especially in the case of endogenous tumors [15].…”

Identification of a Gene Signature for Renal Cell Carcinoma–Associated Fibroblasts Mediating Cancer Progression and Affecting Prognosis

“…A prognosis of advanced renal cancer is difficult to be significantly improved by drug treatment (Liu et al, 2018 ; Yang et al, 2019 ). The mechanism of renal cancer progression is still unclear; however, the role of TME in KIRC is gaining attention (Vuong et al, 2019 ).…”

Feasibility of single position laparoscopic radical nephrectomy and tumor thrombectomy for left renal cell carcinoma with high-risk Mayo grade 0 and 1 tumor thrombus

“…Determine the corresponding surgical strategy according to the height of the TT; 4. Using the laparoscopic ultrasonography in this operation to detect the location of the TT in the vein, determine the size of the TT, and detect the specific position of the end of the TT to determine how to block the vein [ 8 – 10 ]; 5. Strictly follow the principle of tumor free and sterile; 6.…”

“…In laparoscopic renal vein/inferior vena cava TT removal surgery, because we cannot accurately determine the position of the end of the TT with the naked eye, it is very dangerous to blindly test before blocking the renal vein or inferior vena cava which increasing the risk of TT shedding. As mentioned earlier, laparoscopic ultrasonography is used in this operation to detect the location of the TT in the vein, determine the size of the TT, and detect the specific position of the end of the TT to determine how to block the vein [ 8 – 10 ]. After the inferior vena cava is incised and the thrombus is removed, check again to prevent residual tumor thrombi.…”