Laparoscopic nephrectomy for T3b tumor
Article published in Urologia Polska 2008/61/Supl. 1.

authors

Marcin Słojewski, Andrzej Sikorski

Katedra i Klinika Urologii PAM w Szczecinie

summary

Introduction.

Kidney cancer with renal vein and/or vena cava involvement occurs in 4-20% of newly diagnosed patients. Radical surgical treatment is considered the treatment of choice. Results of treatment with successfully and radically removed renal thrombus does not significantly differs from those with organ confined disease. Growing experience and laparoscopic techniques has been expanded to single cases or series of nephrectomy in patients with preoperatively diagnosed venous invasion.

Objectives.

This video presents pure laparoscopic radical nephrectomy performed due to kidney tumor with thrombus extending into the renal vein and vena cava.

Materials and methods.

The case of 68-years old man is presented. Computed tomography showed the right kidney tumor with venous thrombus. Standard retroperitoneal laparoscopic approach with 4 trocars has been applied. After dissection of the hilum renal artery and accessory renal vein were secured with metal clips. Main renal vein containing movable thrombus was localized. Thrombus was proximally milked away from vena cava into the renal vein to prevent inadvertent tumor stapling.This manoeuvre has been previously described in urological literature. Endoscopic stapler was clamped and fired on the uninvolved venous wall. Typical laparoscopic nephrectomy was performed afterwards. The specimen was entrapped in a laparoscopic, plastic bag and removed through a muscle splitting incision in the ipsilateral lower abdomen.

Results.

Operation time was 130 minutes and the blood loss 50ml. The weight of the specimen was 460g. Postoperative course was uncomplicated, patient was discharged in 4th day after surgery. Pathology report revealed clear cell cancer (Fuhrman grade 2) with negative margins on the venous cutting line.

Conclusions.

Laparoscopic nephrectomy for stage T3b is feasible with adherence to mandatory oncologic principles.