Elsevier

Urology

Volume 68, Issue 4, October 2006, Pages 723-727
Urology

Adult urology
Intraoperative laparoscopic renal ultrasonography: Use in advanced laparoscopic renal surgery

https://doi.org/10.1016/j.urology.2006.04.022Get rights and content

Abstract

Objectives

To highlight the use of intraoperative laparoscopic ultrasonography (ILUS) in complex renal surgery, as well its impact on management. ILUS has been used to facilitate advanced laparoscopic surgery, but only limited descriptions of the indications for its use have been published.

Methods

All patients undergoing laparoscopic renal procedures requiring ILUS from October 2001 to March 2005 were reviewed. A total of 50 cases, including 35 partial nephrectomies, cryoablation of 6 renal tumors, 6 radical nephrectomies, 2 perinephric explorations, and 1 resection of a renal artery aneurysm were assessed by ILUS.

Results

The average tumor size in the patients undergoing laparoscopic partial nephrectomy was 3.1 cm (range 1.4 to 8.0), and all margins were negative. Also, a previously unidentified satellite lesion was found in 1 patient. ILUS was essential in assessing iceball formation during laparoscopic renal cryotherapy. ILUS also proved useful in defining the anatomy during laparoscopic perinephric exploration, assessing renal vein thrombi during laparoscopic nephrectomy, and evaluating renal perfusion during laparoscopic renal artery aneurysm repair.

Conclusions

ILUS can be extremely useful in advanced laparoscopic renal surgery. In a number of situations, it is an essential surgical tool. With expanding indications for laparoscopic surgery, the indications for ILUS continue to grow.

Section snippets

Material and methods

All patients undergoing laparoscopic renal procedures requiring ILUS from October 2001 to March 2005 were reviewed. A total of 50 cases, including 35 partial nephrectomies, cryoablation of 6 renal tumors, 6 radical nephrectomies, 2 perinephric explorations, and 1 resection of a renal artery aneurysm were assessed by ILUS.

Partial Nephrectomy

During our early experience with partial nephrectomy, ILUS was not used and successful partial nephrectomies were performed with negative margins. However, all 14 excised tumors were exophytic, with a mean tumor size of 1.6 ± 0.6 cm.7 In contrast, the mean tumor size in the 35 patients in the present study was 3.1 cm (range 1.54 to 8). Also, the collecting system was never entered in our early experience without ILUS, but in our latter experience, the collecting system was entered 22 of 35

Comment

Because ILUS is rarely helpful in standard laparoscopic nephrectomy procedures, published urologic reports of the use of ILUS have been limited to several short reviews in renal surgery.8, 9 As an early proponent of ILUS, Matin and Gill9 reviewed the use of ILUS in lymphocelectomy, renal cyst decortication, nephrolithotomy, and cryosurgery. Gill et al.10 also promoted the use of ILUS in their extensive laparoscopic partial nephrectomy series. Others have similarly indicated an invaluable role

Conclusions

ILUS has become an important adjunct to advanced laparoscopic renal surgical procedures, and, in selected cases, ILUS plays a critical role. With the advancement of laparoscopy into the realm of increasingly complex procedures, its role continues to be defined.

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