Laparoscopic nephron-sparing surgery in a patient with multiple tumours in a solitary kidney

Czech version

Authors: Michael Pešl ¹; Květoslav Novák ¹; Petr Macek ²; Jan Novák ¹; Pavel Dundr ³; Tomáš Hanuš ¹
Authors‘ workplace: Urologická klinika VFN a 1. LF UK, Praha ¹; Departement of Urology, Institut Montsouris, Paris, France ²; Patologický ústav VFN a 1. LF UK, Praha ³
Published in: Ces Urol 2021; 25(1): 13-14
Category: Video

Overview

Pešl M, Novák K, Macek P, Novák J, Dundr P, Hanuš T. Laparoscopic nephron-sparing surgery in a patient with multiple tumours in a solitary kidney.

Aim: To present a video of laparoscopic kidney resection in a patient with multiple tumours of a right sided solitary kidney.

Material and methods: Female patient, 63 years of age, after open transperitoneal nephrectomy on the left, histology confirmed clear cell renal carcinoma (pT2b G3). Two new tumours in the right solitary kidney were found during staging CT. The patient was indicated for laparoscopic nephron-sparing surgery. We found another five small tumours during the procedure. PADUA score: 2x, 9a, 5x, 7a. We resected all the tumours into macroscopicaly negative margins from four resection defects. We used selective clamping (WIT 19 min) during resection of the biggest tumour. We used V-Loc™ stitch to close the defects.

Results: Blood loss was up to 100 ml, no significant renal function impairment was detected. No postoperative complicaions were present. Total hospital stay was 10 days. Result of histopathologic assesment was clear cell carcinoma pT1a G2, there was positive surgical margin in one tumor (the biggest tumour, 12x11 mm) of 2 mm in size.

Conclusions: Laparoscopic nephron-sparing surgery of solitary kidney is a safe, feasible, but technically demanding method of multiple kidney tumours treatment. The patient is free of disease after 12 months from the surgery.

Keywords:

laparoscopy – nephron-sparing surgery – kidney tumour

Sources

1. Hora M, Eret V, Stránský P, et al. Laparoskopická resekce tumorů ledvin (video). Ces Urol 2015; 19(2): 103–105.

2. Macek P, Novák K, Pešl M, et al. Laparoskopická resekce ledviny – komplexní hodnocení perioperačních výsledků jednoho centra. Ces Urol 2019; 23(3): 221–229.