LAPAROSCOPIC PARTIAL NEPHRECTOMY WITH SUPERSELECTIVE BALLOON EMBOLIZATION OF RENAL ARTERY


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Abstract

Aim To use superselective balloon embolization of segmental branches of the renal artery for intraoperative hemostasis during partial nephrectomy for renal malignancy. Materials and methods From October 2015 to September 2016, 11 patients, including 3 males and 8 females aged 29-72 (mean 56.8) years underwent laparoscopic partial nephrectomy with superselective balloon embolization. In 5 and 6 cases the tumors were located in the right and left kidney, respectively, and in 7, 1 and 3 cases they were found in lower, upper and middle segments, respectively. The of tumor size ranged from 0.9 to 3.8 cm (mean 1.9 cm). All patients underwent standard preoperative evaluation including urinary tract ultrasound, multislice computed tomography (MSCT) with contrast enhancement, renal scintigraphy and separate assessment of each kidney function. The complexity of the planned partial nephrectomy was evaluated using a R.E.N.A.L. nephrometry scoring system based on MSCT data. The mean score averaged 5.1 points, which corresponds to a low complexity for resection. Results and discussion The mean blood loss was 50 mL. The duration of laparoscopic stage was reduced from 150 to 60 minutes averaging 104.3 minutes. Mean total operating time from the beginning of selective renal angiography to laparoscopic wound suturing was 168.5 minutes. The mean renal ischemia time was 112.5 (90 to 150) minutes, which was due to performing different stages of the operation in different operating rooms. Given superselectivity of embolization, ischemic changes occurred only in a limited part of the parenchyma surrounding the tumor. Using balloon occlusion, unlike permanent embolization by microgranules, coils or other embolic agents, minimized ischemic injury of intact parenchyma around resected tumors. At the same time, it provided completely dry resection margins for full control. Renal ultrasound on the 3d-4th day postoperatively showed no pathological formations in the perirenal space and no changes in the pelvicalyceal system and kidney size. Conclusion The proposed method of superselective balloon embolization of renal artery branches helped maintain blood circulation in intact parenchyma, which was an important factor in preventing acute renal injury during organ-sparing operations.

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About the authors

A. V Maksimov

Republican Hospital №1National Medical Center

Email: maximov_alex1971@mail.ru
Head of the Department of Urology Yakutsk, Russia

A. G Martov

CCH №57; FMBA

Dr.Med.Sci., Prof., Head of Department of Urology; Head of Department of Urology Moscow, Russia

L. P Pavlov

Republican Hospital №1National Medical Center

Head of the Department of Diagnostic and Interventional Radiology Yakutsk, Russia

P. A Neustroev

Medical Institute, M.K. Ammosov North-Eastern Federal University

PhD, Associate Professor at the Department of Hospital Surgery and Diagnostic Radiology Yakutsk, Russia

R. R Vinokurov

Medical Institute, M.K. Ammosov North-Eastern Federal University

PhD Student at the Department of Hospital Surgery and Diagnostic Radiology Yakutsk, Russia

References

  1. Аляев Ю.Г., Шпоть Е.В. Рак почки. Прошлое, настоящее и будущее. Фарматека. 2010;18-19:14-19.
  2. Chow W.H., Devesa S.S., Warren J.L., Freumeni J.F.Jr. Rising incidence of renal cell carcer in the United States. JAMA. 1999; 281:1628-1631.
  3. EUA Guidelines, 2013, http://www.uroweb.org/guidelines/ onlineguidelines.
  4. Haber G.P., Gill I.S. Laparoscopic partial nephrectomy: contemporary technique and outcomes. Eur. Urol. 2006;49: 660-665.
  5. Nguyen M.M., Gill I.S., Ellison L.M. The evolving presentation of renal carcinoma in the United States: trends from the Surveillance, Epidemiology, and End Results program. J. Urol. 2006; 176: 2397-2400.
  6. Wille A.H., Tullmann M. and Roigas J., Loening S.A., Deger S. Laparoscopic partial nephrectomy in renal cell cancer-results and reproducibility by different surgeons in a high volume laparoscopic center. Eur. Urol. 2006;46:337-343.
  7. Delakas D., Karyotis I., Daskalopoulos G., Terhorst B., Lymberopoulos S., Cranidis A. Nephron-sparing surgery for localized renal cell carcinoma with a normal contralateral kidney: a European three-center experience. J. Urol. 2002;60(6):998-1002.
  8. Gill I.S., Colombo J.R. Jr, Moinzadeh A., Finelli A., Ukimura O., Tucker K., Kaouk J., Desai M. Laparoscopic partial nephrectomy in solitary kidney. J. Urol. 2006;175:454-458.
  9. Marszalek M., Meixl H., Polajnar M., Rauchenwald M., Jeschke K., Madersbacher S. Laparoscopic and open partial nephrectomy: a matched-pair comparison of 200 patients. Eur. Urol. 2009;55(5):1171-1178.
  10. Peycelon M., Hupertan V., Comperat E., Renard-Penna R., Vaessen C., Conort P., Bitker M.O., Chartier-Kastler E., Richard F., Rouprêt M. Long-term outcomes after nephron sparing surgery for renal cell carcinoma larger than 4 cm. J. Urol. 2009;181(1):35-41.
  11. Raz O., Mendlovic S., Shilo Y., Leibovici D., Sandbank J., Lindner A., Zisman A. Positive surgical margins with renal cell carcinoma have a limited influence on long-term oncological outcomes of nephron sparing surgery. Urology. 2010;75(2):277-80. doi: 10.1016/j. urology.2009.06.110. Epub 2009 Nov 6.
  12. Кит О.И., Франциянц Е.М., Димитриади С.Н., Каплиева И.В., Трепитаки Л.К., Черярина Н.Д., Погорелова Ю.А. Роль маркеров острого повреждения почек в выборе тактики хирургического лечения больных раком почки. Онкоурология. 2015;3:34-39
  13. Thompson R.H., Lane B.R., Lohse C.M., Leibovich B.C., Fergany A., Frank I., Gill I.S., Blute M.L., Campbell S.C. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol. 2010;58:340-345.
  14. Patel A.R., Eggener S.E. Warm ischemia less than 30 minutes is not necessarily safe during partial nephrectomy: every minute matters. Urol. Oncol. 2011;29(6):826-828.
  15. Papalia R., Simone G., Ferriero M., Costantini M., Guaglianone S., Forastiere E., Gallucci M. Laparoscopic and robotic partial nephrectomy with controlled hypotensive anesthesia to avoid hilar clamping: feasibility, safety and perioperative functional outcomes. J. Urol. 2012;187(4):1190-1194.
  16. Novak R., Mulligan D., Abaza R. Robotic partial nephrectomy without renal ischemia. J. Urol. 2012;79(6):1296-1301.
  17. Gill I.S., Patil M.B., Abreu A.L. Zero ischemia anatomical partial nephrectomy: a novel approach. J. Urol. 2012;187(3):807-814.
  18. Мосоян М.С., Аль-Шукри С.Х., Семенов Д.Ю., Есаян А.М., Ильин Д.М. Селективная ишемия почечной паренхимы как альтернатива традиционному пережатию сосудистой ножки при резекции почки. Вестник урологии. 2014;3: 3-11
  19. Li C.C., Chou Y.H., Wu W.J., Shih M.C., Juan Y.S., Shen J.T., Liu C.C., Huang S.P., Huang C.H. Laparoscopic partial nephrectomy: the effect of preoperative tumor embolization. Kaohsiung J. Med. Sci. 2007;23(12):624-30. doi: 10.1016/S1607-551X(08)70061-5.
  20. Simone G., Papalia R., Guaglianone S., Carpanese L., Gallucci M. Zero Ischemia Laparoscopic Partial Nephrectomy After Superselective Transarterial Tumor Embolization for Tumors with Moderate Nephrometry Score: Long-Term Results of a Single Center Experience. J. Endourol. 2011, 25(9): 1443-1446. Doi: 10.1089 end.2010.0684.
  21. D’Urso L., Simone G., Rosso R., Collura D., Castelli E., Giacobbe A., Muto G.L., Comelli S., Savio D., Muto G. Benefits and shortcomings of superselective transarterial embolization of renal tumors before zero ischemia laparoscopic partial nephrectomy. Eur J Surg Oncol. 2014;40(12):1731-37. doi: 10.1016/j.ejso.2014.08.484.

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