Author/Editor     Zupančič, Marko; Vodopija, Nado; Kramer, Franc; Krstanoski, Zoran; Koršič, Ljubo
Title     Transperitonealna laparoskopska radikalna nefrektomija
Translated title     Transperitoneal laparoscopic radical nephrectomy
Type     članek
Source     Zdrav Vestn
Vol. and No.     Letnik 75, št. 12
Publication year     2006
Volume     str. 795-9
Language     slo
Abstract     Background Our purpose was to present our experiences with transperitoneal laparoscopic radical nephrectomy in patients with renal cancer and to compare our results with those published in the literature. Patients and methods Between June 2000 and March 2006 in 11 patients with age range 39 to 82 years (mean 56.3 years) in whom the renal cancer was found, we tried to do transperitoneal laparoscopic radical nephrectomy. For diagnosis of renal cancer abdominal ultrasound, CT scan, chest X-ray, blood and urine tests were done. During operative procedures we measured the operating time and blood loss. After procedure we registered analgesics needs of patients, hospital stay and patient's return to normal activity. In all cases pathological examination of the specimen was done. Results Laparoscopic procedure was performed entirely in 8 patients. We have to reoperate 1 patient on second day after the first procedure because of the bleeding caused by blood coagulation disturbances. In 3 patients conversion into classical technique was necessary (major bleeding or technical difficulties). In 2 patients among 8 cases we finished the laparoscopic procedure using the hand-assisted technique. All patients had a renal cell carcinoma, 4 patients (50%) in stage pT1, 2 (25 %) in stage pT2 and 2 (25%) in stage pT3. The mean operating time was 209 minutes. Two patients were transfused with packed red cells. Analgesics were in all patients necessary on the day of operating procedure and the day after. The postoperative hospitalization range was 4 to 7 days. The patients began with normal physical activity 5 to 5 day after surgery. Conclusions Our initial results with transperitoneal laparoscopic radical nephrectomy are comparable with those published in the literature. We believe that use of proper vascular staplers, other needful instruments and more experiences can significantly reduce the operating time.
Summary     Izhodišča Namen prispevka je predstaviti naše izkušnje s transperitonealno laparoskopsko metodo radikalne nefrektomije pri bolnikih z rakom ledvice in jih primerjati z rezultati, ki so dostopni v strokovni.literaturi. Bolniki in metode Med junijem 2000 in marcem 2006 smo pri 11 bolnikih, starih od 39 do 82 let (povprečno 56,3 leta), pri katerih smo ugotovili raka ledvice, naredili ali poskusili narediti transperitonealno laparoskopsko radikalno nefrektomijo. Diagnozo ledvičnega raka smo postavili na osnovi UZ in CT slikanja trebuha, rentgenograma pljuč ter laboratorijske analize krvi in urina. Med laparoskopskim posegom smo pri vseh bolnikih beležili trajanje operativnega posega in izgubo krvi, po posegu pa smo naredili patohistološki pregled preparata ter kontrolirali potrebo po analgetikih, trajanje hospitalizacije in čas do vključitve v običajne telesne dejavnosti bolnikov. Rezultati Pri 8 bolnikih smo uspeli narediti transperitonealno laparoskopsko radikalno nefrektomijo v celoti, pri 3 bolnikih pa je bil zaradi različnih vzrokov (obsežna krvavitev, tehnične težave) potreben preklop v klasično operativno tehniko. Pri 2 od 8 bolnikov smo ob zaključku laparoskopskega operativnega posega uporabili modifikacijo ročno asistirane laparoskopske operativne metode, v 1 primeru pa je bila zaradi krvavitve drugi pooperativni dan potrebna klasična ponovna operacija. Med laparoskopsko operiranimi bolniki je pri 4 (50%) šlo za svetlocelični karcinom stadija pT1, pri 2 (25%) za pT2 in pri 2 (25%) za p2T3. Povprečno je operativni poseg trajal 209 minut. Pri dveh bolnikih je bilo potrebno medoperativno nadomeščanje krvi. Analgetično zdravljenje je bilo pri vseh bolnikih potrebno na dan operativnega posega in prvi pooperativni dan. Hospitalizacija po opravljenem posegu je znašala od 4 do 7 dni. Bolniki so začeli opravljati običajne telesne dejavnosti 5 do 15 dni po opravljenem operativnem posegu. (Izvleček skrajšan na 2000 znakov)
Descriptors     KIDNEY NEOPLASMS
NEPHRECTOMY
SURGERY, LAPAROSCOPIC
TREATMENT OUTCOME