Percutaneous hook wire assistance during laparoscopic excision of an intrarenal mass

Abstract

Completely endophytic renal tumours pose challenges in laparoscopic nephron-sparing tumour excisions, with the use of intraoperative imaging techniques (e.g. ultrasound) being crucial when managing such tumours. The use of a percutaneous hookwire for tumour localisations are in use in several other surgical fields, such as breast surgery. An asymptomatic 52-year-old man presented with an incidental small right sided solid 33-mm interpolar renal mass identified on computed tomography. A guided insertion of a percutaneous localisation wire was carried out prior to a laparoscopic partial nephrectomy to assist in intraoperative tumour landmark/margins identification. Operative time was 210 minutes with zero ischaemia time, with an estimated blood loss of 200 ml. No perioperative complications were observed and the patient was discharged two days postoperatively. Histology revealed the mass to be a Fuhrman grade 2 clear-cell carcinoma with a 2-mm clear surgical margin. The patient remained free of recurrence at 16 months of follow-up. We have reported our first experience of wire localisation prior to laparoscopic partial nephrectomy for an intrarenal mass, which to our knowledge could be the first of its kind in renal surgery. Percutaneous wire localisation of endophytic renal tumours is potentially safe and effective and can allow nephron-sparing surgery where laparoscopic ultrasound is not available. Longer-term and further evidence should be encouraged.

Hook-wire assisted localization of a completely endophytic renal mass during three-dimensional laparoscopic partial nephrectomy: Presentation of our technique

“…Reviewing the literature, two cases of HW tumor localization during LPN have been reported, to the best of our knowledge. 1,2 Both resulted in successful endophytic RM localization and excision, NSMs and no perioperative complications. 1,2 Kouriefs et al also used a ruler for tumor demarcation.…”

“…Completely endophytic renal masses (RMs) are considered a surgical challenge with respect to their identification and resection due to their intraparenchymal growth, which does not alter the renal rim and does not provide haptic feedback during minimally invasive nephron-sparing procedures. 1,2 Intraoperative ultrasound (US) is a useful tool in localization of such tumors during laparoscopy, with positive oncologic outcomes reported so far in the literature. 1,2 Another option is near-infrared fluorescence imaging using indocyanine green dye.…”

“…2 Computed Tomography (CT)-guided hook-wire (HW) placement for tumor localization has gained popularity during the last years mainly in breast and lung surgery, as an effective and safe technique. 1 We present our technique using a HW in order to overcome the "tumor identification problem" during threedimensional (3D) LPN, in a patient bearing a completely endophytic, cT1a RM.…”

Percutaneous Microcoil Localization of a Small, Totally Endophytic Renal Mass for Nephron-Sparing Surgery: A Case Report and Literature Review

“…In addition, the preoperative superselective transarterial delivery of a lipidolindocyanine green (ICG) mixture to trace endophytic tumours has been described [3,9], but related transarterial liquid diffusion and allergy must be taken into account. There has also been a case report on the application of hook-wire localization prior to laparoscopic partial nephrectomy for an intrarenal mass [4]; nevertheless, persistent pain is problematic.…”

“…Small, totally endophytic renal masses present a technical challenge for surgical extirpation due to poor identi ability during surgery. There are dozens of technology-enhanced methods for tumour localization in several surgical specialities [1][2][3][4][5]. However, the method for the precise localization of totally endophytic tumours before nephron-sparing surgery could be optimized.…”