Ivan Schwartzmann

Renal and Adrenal Minilaparoscopy: A Prospective Multicentric Study.

OBJECTIVE To investigate the role of contemporary minilaparoscopy (ML; 3 mm instruments and laparoscope) and to identify predictive factors for complications in a prospective multicenter series for renal and adrenal surgeries. MATERIALS AND METHODS From July 2013 to December 2014, 110 patients from 6 laparoscopic Spanish centers were enrolled. A common database was used and data were collected in a prospective manner. Standard approach was defined as 3 to 4 3-mm trocars with a 3-mm laparoscope and 3-mm instruments (Karl Storz, Tuttlingen, Germany). Descriptive variables were analyzed and statistical analysis was performed for predictive factors for complications. RESULTS Patient mean age was 57.8 ± 14.6 years, with an average body mass index of 25.3 ± 3.6 kg/m(2). Median American Society of Anesthesiologists score was II and 32% (n = 35) of the patients had a previous surgery. A total of 59 nephrectomies, 20 partial nephrectomies, 9 nephroureterectomies, 13 pyeloplasties, 3 pyelolithotomies, and 6 adrenalectomies were performed. Overall operative time was 180 ± 64 minutes. There were 12 clampless partials and 8 with a mean warm ischemia time of 14 ± 7 min. There were 5% of intraoperative and 8% of postoperative complications (Clavien II-IV). Mean hospital stay was 5 ± 2.3 days, with optimal pain and cosmetic control. CONCLUSION To our knowledge, this is one of the largest prospective series of ML for renal and adrenal surgeries. Despite a mean operative time possibly longer than in standard laparoscopy, clinical and safety outcomes are not compromised. Furthermore, ML results in excellent pain control and cosmetic outcomes.

Upper Urinary Tract Urothelial Carcinoma Tumor Seeding along Percutaneous Nephrostomy Track: Case Report and Review of the Literature.

Upper urinary tract urothelial carcinomas (UTUC) account for 5-10% of all transitional cells neoplasms. Kidney-sparing treatment should be considered for low grade (LG) UTUC and for imperative conditions. Percutaneous approach may have a role in LG tumors not manageable endoscopically. Tumor seeding along nephrostomy track is a rare report. We describe the case of a 73-year-old male, with a history of high-grade UC of the left renal pelvis. A CT scan showed the thickening of left renal pelvic wall, and percutaneous biopsy was performed. The patient underwent laparoscopic left nephroureterectomy. Seven months later, he was admitted for left flank pain due to a mass along the percutaneous track site. Mass en-bloc resection was performed, and histopathology finding demonstrated undifferentiated carcinoma, compatible with UTUC metastasis. The percutaneous approach should be considered to be the possible cause of tumor seeding. Multimodal therapy seems mandatory, as highlighted in our outcomes, with 5 years of recurrence free survival.

V10-03 ROBOT ASSISTED BILATERAL URETERAL REIMPLANTATION ON STUDER NEOBLADDER WITH EXPOSURE OF ILIAC ARTERY PROSTHESIS

ureterolysis/omental wrap procedure for presumed retroperitoneal fibrosis after failed medical management. Fibrosis was isolated to the region of a tortuous left iliac artery, which was likely due to trauma from a prior femoral artery catheterization during a cardiac procedure. The ureter was freed of fibrotic attachments and covered with an omental wrap. The patient did well for 1 year, but eventually developed recurrent ureteral obstruction with a 6cm mid/upper ureteral stricture requiring nephrostomy drainage and stent. He elected to undergo BMG ureteroplasty. For both robotic procedures, the patient was positioned in modified lateral decubitus lithotomy position with ports similar to a pyeloplasty. For the ureteroplasty, the mouth was prepped separately for BMG harvest. Ureteroscopy and near-infrared fluorescence were used to define the proximal and distal extent of the stricture. The stricture was measured and the BMG was harvested accordingly. A ureterotomy was made along the length of the stricture over the ureteroscopy. The BMG was sewn to the ureteral edges as an onlay patch. Ureteroscopy was used to confirm patency and a stent was placed. An omental wrap was sutured over the ureter and BMG for blood supply. RESULTS: The patient underwent an uncomplicated ureterolysis procedure with an EBL of 75cc, OR time of 280 minutes, and a hospital stay of 3 days. He is doing well with followup <1 year with no complications or evidence of obstruction. CONCLUSIONS: We describe a case of robotic ureterolysis followed by robotic BMG ureteroplasty in the same patient. Robotic BMG ureteroplasty is an option for patients with long ureteral strictures with proximal extent, and is an alternative to autotransplantation or ileal ureter.

V5-11 INTRASINUSAL DISSECTION AND 3-MM OFF-CLAMP RENAL TUMORECTOMY BY RETROPERITONEOSCOPY

INTRODUCTION AND OBJECTIVES: The renal cell carcinoma has a known tendency to spread forming tumor thrombus to the renal vein or inferior vena cava (4-10%) The level that reach the tumor, it’s in direct relation with the 5-years survival METHODS: We show a case of a male 58 years old patient with history of diabetes and smoking. The patient complains of hematuria that started ten months ago. In the general lab work, the patient was anemic with a hemoglobin of 8 gr/dL and a serum creatinine of 1.1 mg/mL. The CT-Scan showed an 18 cm right kidney tumor with a thrombus in the inferior vena cava up to the diaphragm (Level III) with no seen metastatic disease or malignant lymphnodes Anterior open nephrectomy was performed, followed by control of inferior vena cava which it’s open entirely to perform the thrombectomy. RESULTS: The estimated operative time was 260 minutes, with a bleeding of 1600ml, requiring 3 units of blood during the surgery. No complications was reported. The post-op management was in the ICU for only 24 hours, with a total of length of stay of 5 days. The patient evolved without any complication, showing in the control lab, a serum creatinine of 1.3 mg/dL. To the date there is no evidence of residual disease, clinical nor in the images. CONCLUSIONS: The radical nephrectomy it’s the standard of care in the, level III inferior vena cava thrombus, in the setting of kidney cancer. It should be done in patients in conditions to have surgery.