[Kidney carboxycryoablation. Pilot study].

AIM: The aim of this experimental study was to evaluate the effect of low temperatures of carbon dioxide on a "living" blood-supplying organ (pig kidney), to determine the possibility of performing cryoablation of kidney tissue with carbon dioxide (carboxycryoablation), as well as to establish experimentally modes of carboxycryoablation of the kidney. MATERIALS AND METHODS: To carry out this experimental study, a female of the mini-pig line was used. We performed laparoscopic access to the kidney for carboxycryoablation. During the freezing of the kidney, three modes were compared: 60, 90, and 120 s on one kidney of one animal. Immediately after the completion of cryoablation, nephrectomy was performed, and the removed kidney was sent for histological examination. According to the histological study, the results of the use of carbon dioxide during cryoablation of porcine kidney tissue were evaluated. RESULTS: Cryoablation based on carbon dioxide (carboxycryoablation) leads to irreversible death (necrosis) and destruction of the affected tissue. A direct relationship between the exposure mode and the size of the cryonecrosis zone was noted. Thus, the most extensive zone of necrosis with a diameter of 10 mm was achieved when performing cryoablation in the exposure mode of 120 s. CONCLUSION: This experiment showed that carbon dioxide-based cryoablation remains a feasible procedure that leads to irreversible death (necrosis) and destruction of the affected tissue. However, further studies on the safety and efficacy of cryoablation of kidney tissue with carbon dioxide are required.

[Two-layer posterior reconstruction of the vesicourethral anastomosis during robotic-assisted radical prostatectomy].

AIM: To study the influence of the technique of posterior reconstruction of the vesicourethral anastomosis (VUA) on the prevention of urinary incontinence after robotic-assisted radical prostatectomy (RARP). MATERIAL AND METHODS: A total of 67 patients (mean age 63 years) with localized prostate cancer were included in the study. All patients were divided into two groups. In the group 1 (n=32) the standard technique of the VUA was used, while in the group 2 (n=35) the two-layer posterior reconstruction was done. The impact of urinary incontinence on the quality of life was analyzed using the ICIQ-SF questionnaire 1, 3 and 6 months after operation. On postoperative days 5-7, all patients underwent cystography to assess the tightness of the VUA. RESULTS: One month after RARP in the group 1 the mean score of ICIQ-SF questionnaire was 6.72, compared to 4.57 in group 2 (p=0.04). After 3 and 6 months the respective values were 3.8 vs. 2.3 (p=0.09) and 1.94 vs. 1.2 (p=0.23), respectively. Cystography revealed no extravasation of the contrast. CONCLUSION: The results of a retrospective comparative study suggest that a two-layer posterior reconstruction of the VUA during RARP, being a simple method, provides better continence rate one month postoperatively compared to standard technique, although larger randomized clinical trials are needed.

[Zero-ischemia nephron-sparing interventions for renal tumor. do we need 3D-modeling?]

INTRODUCTION: our aim was to assess and compare a zero ischemia enucleation and enucleoresection of tumor, as well as classical partial nephrectomy. In addition, we defined a role of a three-dimensional reconstruction of the tumor for the planning of intervention. MATERIALS AND METHODS: a total of 83 patients with localized renal tumors were included in the study. There were 48 men (57.8%) and 35 women (42.2%), with mean age 56.8+/-11.9 years. The patients were divided into 3 groups depending on the type of intervention. The enucleation, enucleoresetion and classical partial nephrectomy with removal of 0.5-1 cm margin of normal parenchyma was performed in Group 1 (n=41), Group 2 (n=31) and Group 3 (n=11), respectively. A computer program Amira was used for the reconstruction of 3D-model of tumor during preoperative planning. On the basis of 3D-model, an information about the structures situated beneath the tumor was obtained, as well as anatomy of vessels and relationship between the renal pelvis system and the tumor. RESULTS: In all cases the interventions were performed laparoscopically. Transperitoneal access was used in 34 (41%) cases, while retroperitoneal access was chosen in 49 patients (59%). The amount of blood loss was higher in 23 patients (27.7%) with tumors located in renal sinus (205.7+/-29.1 ml), than in patients with exophytic and endophytic tumors (142.3+/-15.2 and 208.2+/-35.9 ml, respectively; p=0.005). The duration of the surgery was less in those cases where parenchyma was under the bottom of the tumor, according to the 3D-model (58.3+/-6.8 min), compared to the patients with collecting system or vessels located under the tumor (87,6+/-5.2 min, p=0.005). The amount of blood loss was 179.4 +/- 41.8 ml in patients with one vessel located beneath the tumor, according to the 3D-model, in comparison with those cases with three vessels (360.0+/-87.2 ml). There was no need for clamping of the renal vessels or conversion to the open surgery. In the enucleation group, neither intraoperative nor postoperative complications were observed. CONCLUSION: According to the results, we can conclude that 3D modeling undoubtedly gives clear advantages for the urologist during the planning of the intervention. Tumor enucleation seems to be the optimal method of partial nephrectomy, which allows to perform a dissection near to the renal sinus with the small risk of complications.