Spyridon Magginas (1839-1920) and One of the First Successful Radical Nephrectomies.

Spyridon Magginas was among the Greek doctors of the turn of the century who trained abroad with the hope of returning to their native country to offer their services. He became a professor in the "Othonion University" of Athens to promote surgery among young physicians. He was raised in an upper social class family and, reportedly, had an arrogant behaviour, which occasionally led him to have ineffective patient interactions. His patient, and an important Greek writer, Emmanuel Rhoides, nicknamed him the "surgeon beast" for neglecting his case. However, Magginas was an innovative surgeon and in 1902, completed the first successful radical nephrectomy in Greece, and possibly one of the first few globally of the 20th century. A key factor in his success was the prioritisation and application of strict antisepsis.

["When all of you will be forgotten, the name Israel will still be shining" : James Israel (1848-1926): a career in the German Empire and his nomination for the Nobel Prize]. / "Wenn Sie alle vergessen sein werden, wird der Name Israel noch leuchten" : James Israel (1848­1926): Eine Karriere im Deutschen Kaiserreich und seine Nominierung für den Nobelpreis.

In 1902, the Berlin Jewish urologist James Israel was nominated for the Nobel Prize in physiology or medicine. Taking scholar, social, and political aspects into consideration, this biographical essay traces how James Israel gained a sound scientific reputation especially in kidney surgery within Imperial Germany and its antisemitic attitude and how he promoted urology to become a specialty in its own right.

[Renal decapsulation for the treatment of anuria : A "forgotten" treatment from the early 20th century]. / Die Dekapsulierung der Niere als Therapie der Anurie : Ein "vergessenes" Therapieverfahren aus dem frühen 20. Jahrhundert.

In the early 20th century, Harrison first performed renal decapsulation in anuric children with scarlet fever and observed improvement in renal function postoperatively. The pathophysiological explanation was seen in intraparenchymal renal pressure due to edema which was improved by surgical decapsulation. The technique of decapsulation was simple excision after incision and blunt dissection of the renal parenchyma. Renal decapsulation then became a procedure commonly used for many indications in inflammatory renal conditions; indications were renal angioneurosis, hydronephrosis, toxic, bacterial and chronic nephritis, renal abscess and even eclampsia. With the beginning of the antibiotic era, renal decapsulation became obsolete and has disappeared from the urological spectrum completely.

From open to robotic partial nephrectomy.

The present study does not establish comparisons of the different techniques (open, laparoscopic and robotic surgery); rather, it analyzes the how, when and why of each of them from a historical perspective. This historical analysis begins in the late XIX century and extends up to the present time. The study examines the principles, the uncertainties regarding the feasibility of the techniques, the failures, the complications, the doubts about whether the right thing is being done, and the success of a surgical treatment which is presently beyond question. The historical account is summarized, since it covers a period of over one hundred years. It is the history written by innovating and inspired men and women who changed the course of the treatment of renal neoplastic disease.

Cooling mechanisms in laparoscopic partial nephrectomy: are really necessary?

OBJECTIVE: The purpose of this review is to provide an overview of the possibilities and drawbacks of the various possibilities of renal parenchymal cooling during laparoscopic partial nephrectomy and also give an outlook into future developments. METHODS: In January 2012 a PubMed Search using the search terms "partial nephrectomy, cooling," followed by a systematic and critical review was performed. CONCLUSION: Renal cooling during laparoscopic partial nephrectomy is a feasible, safe and effective procedure to expand ischemia time up to over 60 minutes, without risking significant and long lasting deterioration of renal function. It can be of value in patients with an imperative indication for partial nephrectomy, like solitary kidneys, synchronous bilateral tumors or renal failure in the opposite kidney as well as for patients at risk for deterioration of renal function and in any situation, where you think to yourself that 20 minutes will be maybe not enough to finish the job technically. Renal arterial perfusion provides the clinically best-studied option in this situation followed by ice-cold saline irrigation. Other surface coolants look promising, but still lack clinical data.

De la nefrectomía parcial abierta a la robótica / From open to robotic partial nephrectomy

En este trabajo no realizaremos un estudio comparativo de las distintas técnicas (abierta, laparoscópica y robótica) sino más bien analizaremos el cómo, el cuándo y el porqué de cada una de ellas desde una perspectiva histórica. Este análisis histórico comenzará desde finales del siglo XIX hasta llegar a nuestros días. En él, relataremos los principios; la incertidumbre de si se puede realizar. Los fracasos; las complicaciones y las dudas del saber si se está haciendo lo correcto. Y los éxitos de un tratamiento quirúrgico que hoy en día está fuera de toda duda. Todo ello resumido, ya que supone más de cien años de historia de la medicina. La historia que han escrito hombres y mujeres inconformistas que cambiaron el rumbo del tratamiento de la patología renal neoplásica(AU)

The present study does not establish comparisons of the different techniques (open, laparoscopic and robotic surgery); rather, it analyzes the how, when and why of each of them from a historical perspective. This historical analysis begins in the late XIX century and extends up to the present time. The study examines the principles, the uncertainties regarding the feasibility of the techniques, the failures, the complications, the doubts about whether the right thing is being done, and the success of a surgical treatment which is presently beyond question. The historical account is summarized, since it covers a period of over one hundred years. It is the history written by innovating and inspired men and women who changed the course of the treatment of renal neoplastic disease(AU)

The inception and formation of the theory of hyperfiltration through the ages.

With the rising incidence of metabolic syndrome and progressive kidney disease, efforts to halt this progression have become the mainstay of therapies in the era of modern nephrology. The necessity of one versus two kidneys has occupied the minds of leading scientists and philosophers throughout the ages and has laid the foundation for our understanding of progressive kidney disease. This review focuses on the major discoveries of the leading thinkers who with their paradigm shifting ideas and skepticism pushed the boundaries of our knowledge and shaped the theory of hyperfiltration.

Open partial nephrectomy. Personal technique and current outcomes.

Modern imaging capabilities has created a renal tumor stage and size migration with approximately 70% of patients today detected incidentally with a median tumor size of 4cm or less. In addition, our current understanding indicates that renal cortical tumors are a family of neoplasms with distinct histopathological and cytogenetic features and variable metastatic potential.The conventional clear cell tumor has a malignant potential and accounts for only 54% of the total renal cortical tumors but 90% of those that metastasize. Radical nephrectomy, whether performed by open or minimally invasive surgical technique, plays an important role in the management of massive renal tumors that have replaced the normal renal parenchyma, invade the the renal vein, and have associated regional lymphadenopathy or metastatic disease. Partial nephrectomy has emerged as the treatment of choice for patients with smaller tumors. This operation can be performed through a "miniflank" surgical incision without rib resection. Complications related to partial nephrectomy, including bleeding, urinary fistula and infection occur in less than 10% of cases. Radical nephrectomy should not be performed for the treatment of small renal tumors since it is associated with the causation or worsening of preexisting CKD which can cause an increased likelihood of cardiovascular morbidity and mortality. Despite a wealth of evidence supporting the more restricted indications for RN, strong evidence exists that it remains over utilized in the United States. Widespread education and training in kidney preserving surgical strategies is essential going forward.

A history and evolution of laparoscopic nephrectomy: perspectives from the past and future directions in the surgical management of renal tumors.

June 25, 2010 marks the twentieth anniversary of the first clinical laparoscopic nephrectomy. Since the advent of this procedure a paradigm shift toward minimally invasive options for urological surgery has been witnessed, resulting in rapid technological innovations and improved patient outcomes. A history of the minimally invasive surgical management of renal masses is presented with a focus on laparoscopic nephrectomy.

Kidney removal: the past, presence, and perspectives: a historical review.

More than 140 years have passed since the first documented planned nephrectomy. Throughout all these years, people gained significant knowledge on the renal functions and diseases, and what is more, the surgical workshop underwent considerable improvement. Initially, the kidney removal operations were performed due to ureterovaginal fistulas and renal lithiasis. Later, they were executed mainly in patients with renal tumors, whereas today, the number of these surgeries tend to decrease to the benefit of nephron sparing procedures. Current nephrectomies are more and more often performed in case of organ donation, what will probably remain the most significant indication for the kidney removal in close future. While the first surgeries were executed with classical surgical methods, nowadays, after years of studies concerning nephron sparing and minimally invasive operations, we can see surgeries carried out through natural body orifices with robotic assistance. In relation to simple surgical operation based on ligation of 3 tubular anatomic structures, we can perceive the true scope of the progress that occurred in surgery. The aim of this article is to present the evolution of indications and operating techniques utilized to remove the kidney in chronological aspect.

Surgical management of renal tumors: a historical perspective.

The modern era of renal surgery began on August 2, 1869 when the first planned nephrectomy on a living human being was performed. Eighteen years later in 1887, the first partial nephrectomy to remove a renal tumor was performed. Both total and partial nephrectomy have become the hallmark surgical procedures used today to treat renal tumors, and their conception and evolution represent two of the most important advances in medicine and surgery. Surgery for kidney cancer continues to evolve. This article traces the history of surgical management for renal tumors.

Archivos Españoles de Urología. Dirección de Enrique Pérez Castro (1944-1980) / Archivos Españoles de Urología. Enrique Pérez Castro direction (1944-1980)

Objetivo: Con ocasión de cumplirse el centenario del nacimiento del Dr. D. Enrique Pérez Castro, fundador, primer director y editor de la publicación Archivos Españoles de Urología y cuando aparece su sexagésimo primer volumen, realizamos un estudio histórico sobre su evolución a lo largo de los 36 años en que la rigió, entre abril de 1944 y diciembre de 1980, de los sesenta y tres años de existencia con que cuenta la revista en la actualidad. Métodos/Resultados: Revisión completa de los 158 ejemplares, junto con los tres extraordinarios, recogidos en los treinta y un volúmenes editados durante el periodo en que la regentó el Dr. Pérez Castro. Conclusión: La publicación, actual decana de la Urología española, desempeñó su objetivo principal de ser el medio de comunicación e intercambio de conocimientos, con la exposición de los trabajos científicos, entre los miembros de la comunidad urológica española que la acogieron con interés y aprobación plena. La labor y entrega del Dr. Pérez Castro como director le confirió una gran calidad y su logro de unirla a la Asociación Española de Urología, lo que demostró su categoría y reforzó su difusión, su aceptación y su continuidad. En sí constituye un documento excepcional y un espléndido compendio histórico de nuestra Urología en la segunda mitad del siglo XX (AU)

Objectives: With the occasion of the centenary of the birth of Dr. Enrique Pérez Castro, founder, first director and editor of the journal Archivos Españoles de Urología, at this time when the issue No. 61 comes out, we performed a historic study of the evolution of the journal throughout the 36 years it was ruled by him, between April 1944 and December 1980. Methods/Results: Complete review of the 158 issues, together with three extraordinary issues, included in the 31 volumes edited in the period Dr. Perez Castro directed it. Conclusions: The journal, senior journal in Spanish Urology, developed its main objective of being the communication and knowledge exchange media, with the exposition of scientific works, among the members of the Spanish urological community who admitted it with interest and complete acceptation. The work and devotion of Dr. Pérez Castro as director conferred the journal a great quality and achieved to join it to the Spanish Association of Urology, which demonstrated its category and reinforced its diffusion, acceptation and continuity. It is by itself an exceptional document and splendid historic synopsis of our urology over the second half of the 20th century (AU)

[Development of nephrectomy during the nineteenth century and its introduction into Spain]. / Desarrollo de la nefrectomía durante el siglo XIX y su introducción en España.

INTRODUCTION AND OBJECTIVES: After first nephrectomy lumbar made by Dr. Simon in 1869, the surgical technique was established and the procedure access was followed by several surgeons with initial controversy between the use of the intra or extraperitoneal access. We carried out a review about the evolution of this surgical procedure among XIX century and of those who were pioneers with this Kind of technique in our country. MATERIAL AND METHODS: We have reviewed books of history of the Urology, the chapters of surgery in classic urology volumes and the oral presentations to the Spanish Medical congresses, until beginning of XX century and the published nephrectomy procedures in medical literature of that time. RESULTS: We analyzed different statistical studies appeared at the time about results of the operation, the decrease of mortality in the nephrectomies made by extraperitoneal access demonstrated its advantage soon. We found out 35 kidney removal performing the lumbar access, carried out in Spain in the last third of the XX century, three by Dr Federico Rubio and Gall in Madrid, in Barcelona by the urologist Dr. Victor Azcárreta Colán and Jose Pages and by the surgeons Drs. Esquerdo and Salvador Cardinal, from Sevilla, Dr Antonio Solano and the canary urologist Dr. Jose Hernández Perez, who were pioneers performing this procedure in our country. CONCLUSIONS: The introduction of nephrectomy by lumbar access in Spain was delayed in relation to the rest of Europe, due to the secular delay that we dragged, only when adequate conditions of the operating rooms, as much as anaesthesia and asepsis and surgical devices tools, guaranteed the success operation, the main surgeon begun to perform it.

Desarrollo de la nefrectomía durante el siglo XIX y su introducción en España / Development of nephrectomy during the nineteentn century and its introduction into Spain

Introducción y objetivos: Tras la primera nefrectomía lumbar realizada por el Dr. Simon en 1869, la técnica quirúrgica quedó perfilada y el procedimiento fue seguido por numerosos cirujanos en controversia inicial entre la utilización de la vía de acceso intra o extraperitoneal. Efectuamos una revisión acerca de la evolución llevada por la operación en el siglo XIX y sobre quienes iniciaron la intervención en nuestro país. Material y Métodos: Hemos revisado los libros de historia de la Urología, los capítulos de cirugía en los tratados clásicos de la especialidad, las comunicaciones a los congresos españoles de Medicina, hasta principios del siglo XX y las operaciones de nefrectomía publicadas en revistas médicas de la época. Resultado. Analizamos diferentes estudios estadísticos aparecidos en este periodo sobre los resultados de la operación, la disminución de la mortalidad en las nefrectomías realizadas por vía extraperitoneal demostró pronto su ventaja. Localizamos 35 extirpaciones renales por medio del acceso lumbar, efectuadas en España en el último tercio del siglo XX, tres del Dr. Federico Rubio y Galí en Madrid, en Barcelona de los urólogos Dr. Víctor Azcárreta Colány José Pagés y de los cirujanos Drs. Esquerdo y Salvador Cardenal, del sevillano Dr. Antonio Solano y del urólogo canario Dr. José Hernández Pérez, quienes fueron los pioneros de la intervención en nuestro país. Conclusión: La introducción de la nefrectomía por vía lumbar en España fue tardía en relación con el resto de Europa, debido al atraso secular que arrastrábamos, únicamente cuando las condiciones generales de los quirófanos, tanto de anestesia como de asepsia y de utillaje quirúrgico, permitían poder abordar con garantía de éxito la operación, los principales cirujanos comenzaron a realizarla (AU)

Introduction and objectives: After first nephrectomy lumbar made by Dr. Simon in 1869, the surgical technique was established and the procedure access was followed by several surgeons with initial controversy between the use of the intra or extraperitoneal access. We carried out a review about the evolution of this surgical procedure among XIX century and of those who were pioneers with this Kind of technique in our country. Material and methods: We have reviewed books of history of the Urology, the chapters of surgery in classic urology volumes and the oral presentations to the Spanish Medical congresses, until beginning of XX century and the published nephrectomy procedures in medical literature of that time. Results: We analyzed different statistical studies appeared at the time about results of the operation, the decrease of mortality in the nephrectomies made by extraperitoneal access demonstrated its advantage soon. We found out 35 kidney removal performing the lumbar access, carried out in Spain in the last third of the XX century, three by Dr Federico Rubio and Galí in Madrid, in Barcelona by the urologist Dr. Víctor Azcárreta Colán and Jose Pagés and by the surgeons Drs. Esquerdo and Salvador Cardinal, from Sevilla, Dr Antonio Solano and the canary urologist Dr. Jose Hernández Perez, who were pioneers performing this procedure in our country. Conclusions: The introduction of nephrectomy by lumbar access in Spain was delayed in relation to the rest of Europe, due to the secular delay that we dragged, only when adequate conditions of the operating rooms, as much as anaesthesia and asepsis and surgical devices tools, guaranteed the success operation, the main surgeon begun to perform it (AU)