Technique for ensuring negative surgical margins during laparoscopic partial nephrectomy.

BACKGROUND AND PURPOSE: Obtaining a negative surgical margin during laparoscopic partial nephrectomy (LPN) is paramount to optimizing the oncologic efficacy of the procedure. Limitations of laparoscopy hinder the ability to extrapolate the intraparenchymal tumor extension from the exophytic portion. We developed a technique wherein ultrasound-confirmed needle localization of the deep tumor margin prior to tumor extirpation ensured negative surgical margins. MATERIALS AND METHODS: Our technique was developed and initially tested using an agar-based ultrasound phantom designed to mimic 2-cm exophytic renal tumors. Needle placement was imaged with ultrasonography and subsequently correlated with findings on sectioning of the tumor mimic. Laparoscopic extirpation of the tumor mimic following needle placement was carried out in a pelvic trainer. The technique has subsequently been incorporated into our LPN technique in four patients. RESULTS: Ultrasound-confirmed needle localization of intraparenchymal tumor extension was feasible and reproducible in an ultrasound phantom. Ultrasound findings correlated with gross findings. Needle placement prior to tumor resection helped to ensure negative surgical margins when applied in the pelvic trainer and when used in three patients. In the remaining patient, improper needle placement resulted in a grossly positive deep margin. CONCLUSION: Ultrasound-confirmed needle placement effectively and reproducibly marks the deep margin of small renal tumors in a mimic as well as in vivo. Our needle technique eliminates the guesswork and unreliability associated with mental visualization and extrapolation of tumor extent during LPN.

Health related quality of life assessments for patients with bladder cancer.

PURPOSE: We review the current data regarding the impact of various therapeutic alternatives for bladder cancer on health related (HR) quality of life (QOL). MATERIALS AND METHODS: A MEDLINE search of the English literature from 1966 to November 2003 using the search terms "cystectomy," "intravesical therapy" or "bladder cancer" and quality of life yielded 33 articles. Studies of metastatic disease were excluded. The method of evaluation of quality of life in each article was assessed, particularly the instruments used and the population studied. RESULTS: The majority of these reports (20 of 33) compared the impact of different types of urinary diversion on quality of life. The reports provided conflicting data, with several studies showing no significant difference in overall QOL. Some studies revealed a greater improvement in HRQOL with time following continent diversion. Only 2 reports discussed evaluation of HRQOL during intravesical therapy. Either an established standardized QOL instrument or an internally validated instrument was used in all but 8 of the studies. No reports compared the HRQOL effects of bladder sparing treatments to radical cystectomy. CONCLUSIONS: There is no single measure of HRQOL predominantly used in patients with bladder cancer. There is a lack of data comparing HRQOL outcomes in patients receiving bladder sparing therapies versus cystectomy. Development of a universally applicable validated instrument would allow a more effective comparison of HRQOL outcomes in these patients as well as in those with superficial and muscle invasive bladder cancer.