Abstract
Introduction:
Large renal-cell carcinoma (RCC) has more vascularity and a greater influence on adjacent organs. 1 We will present several cases of large tumors with preoperative radiological findings.
Materials and Methods:
Eighty-eight patients with large RCC underwent laparoscopic radical nephrectomy between 1997 and 2009. There were eight cases (9%) of intraoperative complications: four vascular complications and four adjacent organ injuries.
Case 1:
An 81-year-old man with a right RCC. Preoperative magnetic resonance imaging showed that the duodenum had adhered to the anterior surface of the kidney. After clamping the renal artery, we revealed the anterior surface of the renal vein and separated the duodenum from the kidney.
Case 2:
A 64-year-old man with a left upper pole RCC. The tumor protruded medially and compressed the pancreas. When the kidney was turned posteriorly for anterior dissection after completion of renal hilum, the dissection injured the pancreas. Prior dissection between the spleen and kidney should have been made, which then would have allowed spleen and pancreas to turn medially together. Fortunately, pancreatic injury was minor and there were no postoperative events.
Case 3:
A 55-year-old man with left RCC with enlarged parasitic vessels. After a slight retraction, massive bleeding began from an enlarged vessel. Finally, we converted to the open procedure. Because early renal arterial control was preferable, preoperative embolization could have been considered.
Case 4:
A 65-year-old man with left RCC with large lymph node surrounding the renal artery. We made an inferior and posterior approach. We dissected along the aorta to the intersection with the renal artery. We treated renal artery and removed kidney with enlarged lymph node.
Case 5:
An 81-year-old man with a right tumor suspected to have invaded Gerota's fascia. The surgeon violated the fascia and the tumor was uncovered. Careful preoperative magnetic resonance imaging evaluation would have helped in determining intraoperative surgical lines.
Conclusion:
To prevent complications in laparoscopic radical nephrectomy for large RCC, careful preoperative evaluation and sometimes inventive surgical tactics are essential.
Runtime of video: 7 mins
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