RESUMO
In the last two decades, the diagnosis and treatment of renal cancer were influenced by new technologies and surgical techniques. The new radiologic methods had a major impact in detecting smaller and asymptomatic tumors, while the minimally invasive options have offered a low-morbidity and high-efficacy individualized treatments to the patients, based on tumor characteristics and associated comorbidities. Herein we present a contemporary review of the minimally invasive approaches to the renal cancer, supported by the large experience with these therapeutic methods at the Cleveland Clinic.
Assuntos
Neoplasias Renais/cirurgia , Nefrectomia/métodos , Ablação por Cateter/métodos , Criocirurgia/métodos , Humanos , Neoplasias Renais/diagnóstico , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Resultado do TratamentoRESUMO
The indication of laparoscopic partial nephrectomy (LPN) has evolved considerably, and the technique is approaching established status at our institution. Over the past 5 years, the senior author has performed more than 450 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique, review contemporary data and oncological outcomes of LPN.
Assuntos
Neoplasias Renais/cirurgia , Laparoscopia , Nefrectomia/métodos , Humanos , Resultado do TratamentoRESUMO
La indicación de la Nefrectomía Parcial Laparoscópica (NPL) ha evolucionado considerablemente y la técnica se está convirtiendo en una opción establecida en nuestro centro. En los últimos 5 años, el autor principal ha realizado más de 450 nefrectomías parciales laparoscópicas en la Clínica Cleveland. Presentamos seguidamene nuestra técnica y revisamos los datos actuales y los resultados oncológicos de la NPL
The indication of laparoscopic partial nephrectomy (LPN) has evolved considerably, and the technique is approaching established status at our institution. Over the past 5 years, the senior author has performed more than 450 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique, review contemporary data and oncological outcomes of LPN
Assuntos
Humanos , Nefrectomia/métodos , Laparoscopia/métodos , Neoplasias Urológicas/cirurgia , Hemostasia Cirúrgica/métodosRESUMO
OBJECTIVES: We present the results of treatment by laparoscopy of two patients with retroperitoneal fibrosis and review the literature since 1992, when the first case of this disease that was treated using laparoscopy was published. We also discuss the contemporary alternatives of clinical treatment with corticosteroids and tamoxifen. CASE REPORT: Two female patients, one with idiopathic retroperitoneal fibrosis, and other with retroperitoneal fibrosis associated with Riedel's thyroiditis, were treated using laparoscopic surgery. Both cases had bilateral pelvic ureteral obstruction and were treated using the same technique: transperitoneal laparoscopy, medial mobilization of both colons, liberation of both ureters from the fibrosis, and intraperitonealisation of the ureters. Double-J catheters were inserted before the operations and removed 3 weeks after the procedures. The first patient underwent intraperitonealisation of both ureters in a single procedure. The other had 2 different surgical procedures because of technical difficulties during the first operation. Both patients were followed for more than 1 year and recovered completely from the renal insufficiency. One of them still has occasional vague lumbar pain. There were no abnormalities in the intravenous pyelography in either case. CONCLUSIONS: Surgical correction of retroperitoneal fibrosis, when indicated, should be attempted using laparoscopy. If possible, bilateral ureterolysis and intraperitonealisation of both ureters should be performed in the same operation.