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Paper Information

Title: 

LAPAROSCOPIC RADICAL NEPHRECTOMY, A REPORT OF THE FIRST 11 CASES IN IRAN

Type: PAPER
Author(s): SIMFOROOSH N.,SHAFI H.*,BASIRI A.,SHARIFI AGHDAS F.,TABIBI A.,NOORALIZADEH A.,MAGHSOUDI R.,MOUSAPOOR E.
 
 *
 
Name of Seminar: CONGREH ANJOMAN UROLOGY IRAN
Type of Seminar:  CONGRESS
Sponsor:  ANJOMAN OROLOGY
Date:  2005Volume 8
 
 
Abstract: 

OBJECTIVE: WE REPORT 11 CASE OF LAPAROSCOPIC RADICAL NEPHRECTOMY (LRN) PERFORMED FOR THE FIRST TIME IN IRAN.
PATIENTS AND METHODS: FROM 2000 TO 2002, 11 PATIENTS WITH ORGAN-CONFINED RENAL MALIGNANCY (T1N0M0 OR T2N0M0) UNDERWENT LRN AT OUR CENTER. OPEN RADICAL NEPHRECTOMY WAS DONE FOR CASES WITH VASCULAR INVOLVEMENT AND/OR ADVANCED LOCAL STAGE. LAPAROSCOPIC SURGERY WAS PERFORMED INTRAPERITONEALLY THROUGH TWO 10 MM PORTS AND ONE 5MM PORT. A FORTH PORT (10MM) WAS USED FOR SOME RIGHT SIDED TUMORS TO IMPROVE UPPER POLE VISUALIZATION.
RESULTS: THE PATIENTS WERE 8 MEN AND 3 WOMEN WITH A MEAN AGE OF 55 YEARS (36-70). MEAN TUMOR SIZE WAS 5.7 CM. TUMORS WERE ON THE RIGHT SIDE IN 6 AND ON THE LEFT SIDE IN 5 PATIENTS. NONE OF THE PATIENTS HAS A HISTORY OF PRIOR INTRAOBDOMINAL SYRGERY. THE KIDNEY WAS REMOVED INTACT THROUGH A PFANNENSTIEL INCISION IN 9 AND A LOWER MIDLINE INCISION IN 1. MEAN OPERATIVE TIME WAS 234 MINUTES AND MEAN DURATION OF HOSPITALIZATION WAS 6.1 DAYS. CONVERSION TO OPEN SURGERY WAS REQUIRED IN ONE OF THE PATIENTS WITH A RIGHT SIDED TUMOR IN WHOM EARLY CLIPPING OF THE RENAL VEIN LED TO RENAL ENGORGEMENT AND BLEEDING. BLOOD TRANSFUSION WAS NEEDED IN 2 OTHER PATIENTS, MEAN TIME TO RESUMPTION OF A REGULAR DIET WAS 35 HOURS POSTOPERATIVELY. TWO PATIENTS REQUIRED ANALGESIC INJECTIONS POSTOPERATIVELY. PATHOLOGIC STAGE WAS T1NXMX IN 7, T2NXMX IN 2, AND T3NXMX IN 1.
DISCUSSION AND CONCLUSION: LRN IS A TECHNICALLY DEMANDING BUT LESS INVASIVE FORM OF SURGERY FOR SMALL AND INTERMEDIATE SIZED RENAL CANCERS WITHOUT VASCULAR INVASION. LRN IS MORE DIFFICULT ON THE RIGHT SIDE BECAUSE OF THE SHORT RIGHT RENAL VEIN AND THE DIFFICULTY IN EARLY VISUALIZATION OF THE RIGHT RENAL ARTERY.

 
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