Laparoscopic Removal of Local Renal Cell Carcinoma Recurrence
Alexander Tsivian, Shalva Benjamin, Avraham Shtricker, Matvey Tsivian, Shlomo Kyzer, A. Ami Sidi
Departments of Urologic Surgery (SK) and Surgery B (AT, SB, AS, MT, AAS), Wolfson Medical Center, Holon, Israel
ABSTRACT
Purpose:To describe an entirely laparoscopic technique for excising a recurrence of local renal cell carcinoma (RCC). Materials and Methods: 7KHSDWLHQWLVSODFHGLQDIXOOÀDQNSRVLWLRQ$PPWURFDULVLQVHUWHGXVLQJ+DVVRQ¶VWHFKQLTXH ZLWKWKUHHDGGLWLRQDOSRUWVLQWKHXSSHUDEGRPHQ$IWHUO\VLVRIDGKHVLRQVWKHSVRDVPXVFOHXUHWHUDODQGJRQDGDOYHLQ UHPQDQWVLQIHULRUYHQDFDYDRUDRUWDDQGUHQDOYHVVHOVWXPSVDUHGLVVHFWHGDQGLVRODWHG7KHVSHFLPHQLQFOXGLQJWKH PDVVWKHDGUHQDOJODQGDQGWKHLSVLODWHUDOSDUDUHQDODQGSDUDFDYDORUSDUDDRUWLFWLVVXHZLWKLQ*HURWD¶VIDVFLDUHPQDQWV DUHH[FLVHGHQEORFDQGUHPRYHGLQVLGHDQ(QGRFDWFK,,EDJ
Results:7RGDWHZHKDYHXVHGWKLVWHFKQLTXHIRUH[FLVLQJ5&&UHFXUUHQFHVLQWKUHHSDWLHQWV3DWKRORJLFH[DPLQDWLRQ showed clear cell type RCC Fuhrman grade 2 in the specimens of two patients and chromophobe type in one. No patient
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Conclusions:$QHQWLUHO\ODSDURVFRSLFVXUJLFDODSSURDFKIRUH[FLVLQJORFDO5&&UHFXUUHQFHKDVQRWWRRXUNQRZOHGJH EHHQSUHYLRXVO\GHVFULEHG7KLVPHWKRGFDQEHHIIHFWLYHO\DSSOLHGZKLOHDGKHULQJWRRQFRORJLFSULQFLSOHVZLWKPLQLPDO
blood loss and low morbidity.
Key words: carcinoma, renal cell; recurrence; laparoscopy
Int Braz J Urol. 2009; 35: 436-41
INTRODUCTION
Local recurrence of renal cell carcinoma
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series of a purely laparoscopic technique for excising local RCC recurrence.
MATERIALS AND METHODS
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technique. We obtained a brief clinical summary
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procedure.
Patients
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left radical nephrectomy 4 years earlier. Two years
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carried out entirely by a laparoscopic transperitoneal
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Surgical Technique
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side and in the anterior axillary line on the left side
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Figure 1 – Magnetic resonance imaging. We can see a 5-cm mass in the kidney bed (arrow), and a 5 cm mass in a single left kidney.
Figure 2 – Sites for proposed trocars placement.
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abdomen.
RESULTS
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technique at our center.
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concomitantly with an open partial nephrectomy
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grade 2 in two patients and chromophobe type RCC
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COMMENTS
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nephrectomy is reported to occur in 2% of patients
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presentation and therapy of isolated local RCC recur
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The reported time to further tumor progres
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tients with isolated local recurrence and 4.2 months
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complete resection may be technically challenging
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for teaching purposes.
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offers the ability to palpate the lesion in the renal
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RCC metastasis resection with a purely laparoscopic technique. They concluded that laparoscopic approach is feasible in experienced hands and may confer the
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days).
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retroperitoneal fat tissue and the ipsilateral adrenal (if
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should only be carried out by experienced surgeons in strict adherence to oncologic principles.
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dards or rules for retroperitoneal dissection. For
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neal lymph node dissection should be performed in all
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nodes were not dissected.
Regarding possible indications for laparo
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Correct trocar placement is essential for a comfortably
performed procedure and minimal limitations of
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triangulation referring to the former renal hilum as
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represents the deep border of dissection whereas the
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limits of the template. These structures are carefully
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minimized. We do not use mechanical suturing in
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as in this case.
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These patients may represent the ideal candidates
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our report is its sample size and results should be interpreted accordingly. Larger series would allow
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remain unclear.
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of a purely laparoscopic resection of solitary renal
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ACKNOWLEDGMENT
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assistance in preparation of this manuscript.
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CONFLICT OF INTEREST
None declared.
REFERENCES
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of isolated renal cell carcinoma fossa recurrence after
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recurrence after radical nephrectomy for renal cell
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Therapy of locally recurrent renal cell carcinoma after
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perience with fossa recurrence of renal cell carcinoma.
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laparoscopic resection of isolated renal cell carcinoma
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Accepted after revision: May 13, 2009
Correspondence address: 'U$YUDKDP6KWULFNHU
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EDITORIAL COMMENT
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radical nephrectomy (4).
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The authors report their experience with the laparoscopic management of local recurrence of RCC
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successful surgery can delay the onset of systemic
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circumstances.
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exists limited data in the literature regarding minimal
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propose this procedure as suitable for highly selected patients.
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laparoscopic surgery will be different in specialized centers as in institutions with a lower case number.
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in open surgery if performed in a specialized center.
REFERENCES
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local recurrence after radical nephrectomy for renal
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