BERKELEY, CA (UroToday.com) - Renal cell carcinoma (RCC) occurs in dialysis patients more frequent than the general non-dialyzed population. RCC in dialysis patients can often be multiple and sometimes occurs bilaterally. Dialysis patients often have poor physical status because of multiple complications such as respiratory or cardiac problems in addition to chronic renal failure (CRF). Here we report the feasibility of sequential bilateral minimum incision endoscopic surgery (MIES) on seven patients on dialysis with bilateral RCCs.

MIES nephrectomy was carried out by retroperitoneal approach through a single minimum incision (median 6cm) that narrowly permitted extraction of the specimen using endoscopy and direct stereovision, without trocar ports, without gas insufflations, and without the insertion of the hands of operators into the operative field. We previously demonstrated MIES nephrectomy had been less invasive than conventional nephrectomy and appropriate to RCC in dialysis patients. Seven patients with bilateral RCCs have undergone sequential bilateral MIES nephrectomies. The perioperative data of the second MIES nephrectomy in these seven patients were compared to that of the first nephrectomy.

Although six of the seven patients had multiple complications in addition to CRF, bilateral kidneys were successfully removed by sequential MIES radical nephrectomy without major operative complication. There was no significant difference between the first and the second nephrectomy in the size of incision, maximum diameter of the resected kidney, operation time or blood loss. Postoperative recovery was prompt with all patients resuming oral feeding and walking by the second postoperative day even in the second nephrectomy.

In conclusion, sequential bilateral MIES radical nephrectomy is a feasible treatment for bilateral RCCs in dialysis patients.

Written by
Mizuaki Sakura, MD, as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

Sequential Bilateral Minimum Incision Endoscopic Radical Nephrectomy in Dialysis Patients with Bilateral Renal Cell Carcinomas - Abstract

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