Surgery Insight: advances in techniques for open partial nephrectomy

Huang, William C.; Kagiwada, Megan A.; Russo, Paul

doi:10.1038/ncpuro0855

Cited by 12 publications

(8 citation statements)

References 31 publications

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“…These factors include: better understanding of the importance of preserving the renal parenchyma -even in cases with normal kidney functions [12,13], comparable oncological results ''with certain criteria'' to RN [14], and technical accessibility with accepted intraoperative and postoperative complications [15].…”

Section: Discussionmentioning

confidence: 99%

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Nephron-sparing surgery for renal tumors

Ezzat

Helmy

Ibrahim

2011

Journal of the Egyptian National Cancer Institute

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Section: Discussionmentioning

confidence: 99%

“…Different ways were currently used to achieve hemostasis after NSS [12,[25][26][27]. Richter et al did not report postoperative bleeding following usage of FloSeal Ò for hemostasis during NSS in 25 patients [27].…”

Section: Discussionmentioning

confidence: 99%

Nephron-sparing surgery for renal tumors

Ezzat

Helmy

Ibrahim

2011

Journal of the Egyptian National Cancer Institute

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“…After 18 months of follow-up, 3.6% of patients reported a bulge (no hernia but muscular atony) at the incision site, and 1 patient was diagnosed with an incisional hernia requiring surgical intervention [64]. In an update of 280 additional cases of open PNs, the median length of stay decreased further to 4 days, mean EBL was 300 mL, and a flank bulge was reported in only 1.8% of patients [65]. Muscle atony/bulge at the incision site without hernia is disconcerting for the patient and can be ameliorated or improved completely by exercises that twist the upper torso and core muscles (using an exercise bar, broom, or golf club).…”

Section: Technical Features Of Open Partial Nephrectomy: Supra 11th Rmentioning

confidence: 99%

Open Mini-Flank Partial Nephrectomy: An Essential Contemporary Operation

Russo

2014

Korean J Urol

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Secondary to the widespread use of the modern imaging techniques of computed tomography, magnetic resonance imaging, and ultrasound, 70% of renal tumors today are detected incidentally with a median tumor size of less than 4 cm. Twenty years ago, all renal tumors, regardless of size were treated with radical nephrectomy (RN). Elective partial nephrectomy (PN) has emerged as the treatment of choice for small renal tumors. The basis of this paradigm shift is three major factors: (1) cancer specific survival is equivalent for T1 tumors (7 cm or less) whether treated by PN or RN; (2) approximately 45% of renal tumors have indolent or benign pathology; and (3) PN prevents or delays the onset of chronic kidney disease, a condition associated with increased cardiovascular morbidity and mortality. Although PN can be technically demanding and associated with potential complications of bleeding, infection, and urinary fistula, the patient derived benefits of this operation far outweigh the risks. We have developed a "mini-flank" open surgical approach that is highly effective and, coupled with rapid recovery postoperative care pathways associated with a 2-day length of hospital stay.

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“…Therefore, many urologists consider a thoracoabdominal incision to be the incision of choice for radical nephrectomy, especially for large renal tumors, but complication is a major concern. Therefore, some urologists have applied other approaches, such as the transabdominal and flank incision [3][4][5]. The flank incision is mainly used for simple nephrolithotomy or nephrectomy, and in some cases for radical or partial nephrectomy, especially for small renal tumors [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Retrospective study of the efficacy and complication of thoracoabdominal incision for nephrectomy: a comparison with flank approach

Yang

Zhao

2009

Front. Med. China

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This retrospective study was performed to compare the outcome of thoracoabdominal incision versus flank incision for radical nephrectomy in the patients with large renal tumors. A questionnaire assessing postoperative pain, administration of pain medications and the return to activities and work was sent to the patients who underwent radical nephrectomy through the 11th rib (group 1: undergoing flank incision, including 96 patients) or the 9th to 10th rib (group 2: undergoing thoracoabdominal incision, including 98 patients) from 2003 to 2007 in our hospital. A case retrospective analysis assessing operation time, perioperative hemorrhage volume, size of tumor, success in the treatment of tumor thrombus in renal vein or vena cava, time length of presence of drainage tube, postoperative analgesia usage and length of stay was conducted in patients whose questionnaires were returned. A total of 56 patients (58%) in group 1 and 60 (61%) in group 2 responded to the questionnaire. Time lengths of operation and presence of abdominal drainage tube were shorter in group 2 than those in group 1. Perioperative hemorrhage volume in group 2 was obviously less than that in group 1. The mean size of tumors in group 1 was significantly smaller than that in group 2 (P < 0.0005). The success rate of treating thrombus in renal vein or vena cava in group 2 was significantly higher than that in group 1 (P < 0.05). Lengths of off-bed time and stay were the same in both groups. There were no differences between groups in terms of pain severity on postoperative day 1, on day of discharge and 1 month postoperatively (P > 0.05). There were no significant differences between groups in the time following surgery when pain completely disappeared, when pain medications were discontinued, and when the patient returned to daily activities and work (P > 0.05). The thoracoabdominal incision provides excellent exposure and allows for early vascular control. Efficacy and complication was comparable for thoracoabdominal and flank incisions in terms of incisional pain, analgesic requirements after discharge and return to normal activities.

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Surgery Insight: advances in techniques for open partial nephrectomy

Cited by 12 publications

References 31 publications

Nephron-sparing surgery for renal tumors

Nephron-sparing surgery for renal tumors

Open Mini-Flank Partial Nephrectomy: An Essential Contemporary Operation

Retrospective study of the efficacy and complication of thoracoabdominal incision for nephrectomy: a comparison with flank approach

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