Application of intraoperative ultrasonography in retroperitoneal laparoscopic partial nephrectomy: A single-center experience of recent 199 cases

Abstract

Objectives: To summarize the value and application experiences of intraoperative laparoscopic ultrasonography (ILUS) in retroperitoneal laparoscopic partial nephrectomy (RLPN).

Materials and methods: From January 2013 to December 2018, RLPN with ILUS was performed on the recent 199 patients in our center (two patients received bilateral RLPN due to suspected malignancy of both right and left sides), and the relevant clinical and follow-up data were retrospectively reviewed. Among them, 119 patients were male and 80 were female; the age of patients was 53.4 ± 12.3 years. Of all the renal tumors, 105 were located on the left side and 96 on the right side with a RENAL score of 6.6 ± 1.7. All the patients were diagnosed as or suspected of having a renal tumor by preoperative imaging examination. The ILUS was applied in all the operations to help locate the tumor, delineate the boundary, clarify the diagnosis, observe the blood supply, and so on.

Results: RLPN with ILUS in these 199 patients was successfully performed without conversion to open surgery. All surgeries were completed in 90.2 ± 21.7 min, with 73.6 ± 89.2 mL for estimated blood loss, and 19.3 ± 5.6 min for warm ischemia time. The tumor size was 3.6 ± 1.5 cm, and all the surgical margins were negative. The drainage days and postoperative hospital days were 4.7 ± 2.3 and 6.1 ± 2.3, respectively. The preoperative creatinine was 69.7 ± 19.4 μmol/L compared with 61.6 ± 12.7 μmol/L measured 1 month postoperatively. There were 17 cases of renal cell carcinoma no more than 1 cm, and they were resected without artery clamp or a large amount of blood loss. Satellite tumors were confirmed in 12 cases, of which 8 were not detected by preoperative examinations and finally found by ILUS during surgeries.

Conclusion: ILUS can alleviate the difficulty of preoperative diagnosis, facilitate surgical dissection, and improve the effect of nephron-sparing surgeries. Due to its great advantage, ILUS should further be promoted and applied.

Keywords: Intraoperative ultrasonography; laparoscopy; partial nephrectomy; renal tumor.

Figure 1

(a) The probe of the ILUS was placed into the retroperitoneal space through the trocar and directly located on the surface of the kidney. (b) The ILUS could provide more information (tumor position, size, peripheral organs and tissue, etc.) for the surgeon. (c) The ILUS could clearly display the blood supply of the renal tumor. (d) After the renal artery was intermittently blocked, the ILUS could help us determine if the artery was completely blocked and there was accessory renal artery. ILUS: Intraoperative laparoscopic ultrasonography

Figure 2

The ILUS scanned a lesion inside the kidney and indicated the possibility of malignancy, which the preoperative CT only provided a vague imaging evidence to the clinicians and brought great difficulty for the accurate diagnosis. ILUS: Intraoperative laparoscopic ultrasonography; CT: Computed tomography