Hai-bo Sheng

Left Transperitoneal Laparoscopic Partial Nephrectomy in the Presence of a Left-sided Inferior Vena Cava

OBJECTIVES To report a case and the surgical techniques of transperitoneal laparoscopic partial nephrectomy (LPN) in a patient with a small left renal mass and an aberrant left-sided inferior vena cava (IVC). METHODS An otherwise healthy 49-year-old man with a body mass index of 23.1 kg/m(2) was diagnosed with a 5 × 6-cm mass in the left kidney. A transperitoneal LPN was performed in the presence of a left-sided IVC. The procedure was completed using standard laparoscopic instruments. The left renal vein was identified, with the gonadal vein used as an anatomic landmark. Slightly rostral to the location where the renal vein emptied into the left-sided IVC, 2 renal arteries were dissected and clamped individually using laparoscopic bulldog clamps. A standard LPN was then completed. RESULTS The duration of the surgery was 182 minutes, and there was an estimated blood loss of 100 mL. The warm ischemic time was 31 minutes. The postoperative recovery was uneventful, and the patient was discharged to his home on postoperative day 7. A pathologic examination revealed a renal oxyphilic adenoma, which is a benign lesion. At the follow-up visits that were 1 month and 3 months after surgery, the patient was determined to be clinically healthy. CONCLUSIONS The anomaly of a left-sided IVC is not an impediment to performing a transperitoneal LPN; however, the correct identification of the anatomical landmarks and the use of meticulous intraoperative techniques are of paramount importance during this procedure.

Left Laparoscopic Radical Nephrectomy in the Presence of a Duplicated Inferior Vena Cava With Complicated Anomalous Tributaries by a Transmesocolic Approach

Laparoscopic radical nephrectomy should be executed under the most fundamental principle of early ligature of the renal artery to prevent diffusion of cancerous cells. This is extremely true in the treatment of large renal tumors touching the main renal vasculature. Obviously, the concomitance of a duplicated inferior vena cava (IVC) with associated aberrant tributaries will significantly increase the surgical difficulty and the procedural risk of vascular injury. Herein we describe a transperitoneal left laparoscopic radical nephrectomy for a large hilar left renal tumor in the presence of a duplicated IVC with complicated anomalous tributaries by a transmesocolic approach.

Transumbilical laparoendoscopic single-site surgery of simple nephrectomy of nonfunctioning kidney： a two-year experience

Abstract Background Laparoendoscopic single-site surgery (LESS) may serve as a potential alternative to conventional laparoscopy and is developing quickly, but still in its infancy. The study is to present our two-year experience in transumbilical LESS simple nephrectomy (LESS-SN) for non-functioning kidney, in an effort to evaluate its feasibility, clinical outcomes and potential advantages. Methods From December 2008 to December 2010, a total of 11 patients with body mass index (BMI) ≤30 underwent transumbilical TriPort™ LESS-SN by a single experienced urologist at our institution. The indications for nephrectomy included nonfunctioning kidney associated with ureteropelvic junction stricture (n=1), ureteral calculi (n=6), tuberculosis (n=3), and ureteral stricture (n=1). Patient demographics, perioperative and follow-up data were prospectively collected and analyzed. Results Ten procedures were successfully completed with one patient converted to open surgery due to uncontrollable bleeding. The mean operative time was 189.2 (ranging 100∼320 min) with an estimated blood loss of 204.5 (ranging 501 000 ml). There were two complications of bleeding (1 intra-, 1 post-). The mean hospitalization after surgery was 7.9 d (ranging 417 d). With a regular follow-up of 1, 6, 12, and 24 months after surgery, all patients remained symptom-free with an intra-umbilical scar. Conclusion Transumbilical LESS simple nephrectomy for nonfunctioning kidney can be accomplished with favorable surgical outcomes and a superiority of cosmesis. However, cases with chronic inflammation are not suitable for initial up-take and should only be attempted by the very experienced laparoscopist.

Synchronous bilateral laparoendoscopic single-site urological surgeries via the umbilicus： a report of 2 cases

Abstract Objective To describe two cases of bilateral transumbilical laparoendoscopic single-site(LESS) surgeries in a single operative session and assess the safety, feasibility and efficacy. Methods One patient underwent right ureterolithotomy and left varicocelectomy, and the patient was performed with right simple nephrectomy for nonfunctioning kidney due to ureteral calculus and left ureterolithotomy using a novel multichannel TriPort™ via a single 2–3 cm transumbilical incision. Results The right-side ureterolithotomy and left-side varicocelectomy were finished in 229 minutes, with a total estimated blood loss of 50 ml. The right-side simple nephrectomy and left-side ureterolithotomy in the other patient were finished in 340 minutes, with a total estimated blood loss of 100 ml. There were no major complications. At the latest follow-up, both patients remained symptom-free and there were no evidences of recurrence. Both of them were delighted for the single scar. Conclusion Synchronous LESS urologic procedure via a single umbilical incision is technically feasible, safe and efficacious with a promising potential.