Occlusion angiography using intraoperative contrast-enhanced ultrasound scan (CEUS): a novel technique demonstrating segmental renal blood supply to assist zero-ischaemia robot-assisted partial nephrectomy.
Eur Urol
; 63(5): 913-9, 2013 May.
Article
en En
| MEDLINE
| ID: mdl-23116657
ABSTRACT
BACKGROUND:
Recent innovations in technology and operative techniques have enabled safe performance of robot-assisted zero-ischaemia partial nephrectomy (PN), thus preventing the deleterious effect of warm ischaemia time.OBJECTIVE:
To describe a novel technique of occlusion angiography using intraoperative contrast-enhanced ultrasound scan (CEUS) for zero-ischaemia robot-assisted PN (RAPN). DESIGN, SETTING, ANDPARTICIPANTS:
We used a prospective cohort evaluation of five patients who had imaging suspicious of renal cell carcinoma (RCC) treated at a single centre. SURGICAL PROCEDURE We used computed tomography with three-dimensional reconstruction to identify renal arterial anatomy and its relationship to the tumour. Then, RAPN was performed with selective clamping and demonstration of a nonperfused segment of kidney (occlusion angiography) using intraoperative CEUS. OUTCOME MEASUREMENTS AND STATISTICALANALYSIS:
We prospectively collected data on baseline, perioperative, and postoperative parameters. RESULTS ANDLIMITATIONS:
We describe the effects seen on ultrasound contrast administration. Contrast flare is seen in the segment of the kidney that is perfused. When selective clamping is performed, a watershed (line of demarcation) between the perfused and nonperfused segments of the kidney is clearly seen, allowing excision of the tumour in a relatively avascular plane and ensuring an adequate oncologic margin, when feasible. The mean age was 68.2 yr of age (range 36-85), and the mean tumour size was 29.6mm (range 20-42). The mean intraparenchymal extension of the tumour was 22.6mm (range 12-30). Three tumours were located on the right kidney and two on the left. The mean blood loss was 420ml (range 200-1000). The histology revealed clear cell RCC in two patients, oncocytoma in two patients, and type 1 papillary RCC in one patient. All the surgical specimens had negative surgical margins. The mean decrease in glomerular filtration rate was 8.4ml (range 0-24). The mean follow-up was 6.4 mo (range 5-8), with no evidence of recurrence in any patient. The only limitation in adopting this technique is the need for an intraoperative ultrasound probe with a CEUS mode. However, most specialists who perform minimally invasive surgery for small renal tumours believe that intraoperative ultrasound scan imaging is essential to achieving adequate resection margins.CONCLUSIONS:
Intraoperative CEUS can be a useful adjunct in determining whether zero-ischaemia RAPN is feasible by delineating the area of nonperfusion. This technique has several advantages over the currently available techniques, such as indigo carmine green and Doppler probes.
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Fosfolípidos
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Hexafluoruro de Azufre
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Robótica
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Carcinoma de Células Renales
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Ultrasonografía Intervencional
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Adenoma Oxifílico
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Medios de Contraste
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Cirugía Asistida por Computador
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Neoplasias Renales
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Nefrectomía
Tipo de estudio:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Aged
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Aged80
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Humans
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Male
Idioma:
En
Revista:
Eur Urol
Año:
2013
Tipo del documento:
Article
País de afiliación:
Reino Unido