Intentional resection of the diaphragm during cytoreductive laparoscopic radical nephrectomy

S. E. Pautler, C. Richards, S. K. Libutti, W. M. Linehan, M. M. Walther

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Purpose: Laparoscopic radical nephrectomy is being performed more commonly. To our knowledge intentional resection of the diaphragm during laparoscopic radical nephrectomy for large renal tumors has not yet been described. We detail the laparoscopic management of diaphragmatic resection. Materials and Methods: From March 1996 to February 2001, 36 patients underwent cytoreductive laparoscopic radical nephrectomy at our institution in preparation for systemic immunotherapy. Charts and operative tapes were reviewed and cases were identified in which diaphragmatic resection was performed for locally invasive tumors. Results: In 3 patients a portion of the diaphragm was dissected via laparoscopy during debulking nephrectomy. All patients had renal cell carcinoma with documented metastatic disease. The diaphragm was repaired laparoscopically using intracorporeal suturing techniques in 2 of the 3 patients and a chest tube was placed in all 3. Transient systolic hypotension and hypercarbia in 1 case resolved with manual ventilation. The chest tube was removed on postoperative days 2 to 4. There were no complications and no ipsilateral pleural metastasis was identified at an average of 6 weeks (range 2 to 23) of followup. Conclusions: A portion of the diaphragm may be intentionally resected during laparoscopic radical nephrectomy. This maneuver may be successfully managed without conversion to an open procedure. In cases of a large diaphragmatic defect or the potential for coagulopathy postoperatively a chest tube should be inserted. Potential invasion of the diaphragm by large tumors should not be considered a contraindication to cytoreductive laparoscopic radical nephrectomy.

Original languageEnglish (US)
Pages (from-to)48-50
Number of pages3
JournalJournal of Urology
Volume167
Issue number1
StatePublished - 2002
Externally publishedYes

Fingerprint

Diaphragm
Nephrectomy
Chest Tubes
Conversion to Open Surgery
Neoplasms
Hypercapnia
Renal Cell Carcinoma
Laparoscopy
Immunotherapy
Hypotension
Neoplasm Metastasis
Kidney

Keywords

  • Diaphragm
  • Kidney
  • Laparoscopy
  • Nephrectomy

ASJC Scopus subject areas

  • Urology

Cite this

Pautler, S. E., Richards, C., Libutti, S. K., Linehan, W. M., & Walther, M. M. (2002). Intentional resection of the diaphragm during cytoreductive laparoscopic radical nephrectomy. Journal of Urology, 167(1), 48-50.

Intentional resection of the diaphragm during cytoreductive laparoscopic radical nephrectomy. / Pautler, S. E.; Richards, C.; Libutti, S. K.; Linehan, W. M.; Walther, M. M.

In: Journal of Urology, Vol. 167, No. 1, 2002, p. 48-50.

Research output: Contribution to journalArticle

Pautler, SE, Richards, C, Libutti, SK, Linehan, WM & Walther, MM 2002, 'Intentional resection of the diaphragm during cytoreductive laparoscopic radical nephrectomy', Journal of Urology, vol. 167, no. 1, pp. 48-50.
Pautler SE, Richards C, Libutti SK, Linehan WM, Walther MM. Intentional resection of the diaphragm during cytoreductive laparoscopic radical nephrectomy. Journal of Urology. 2002;167(1):48-50.
Pautler, S. E. ; Richards, C. ; Libutti, S. K. ; Linehan, W. M. ; Walther, M. M. / Intentional resection of the diaphragm during cytoreductive laparoscopic radical nephrectomy. In: Journal of Urology. 2002 ; Vol. 167, No. 1. pp. 48-50.
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N2 - Purpose: Laparoscopic radical nephrectomy is being performed more commonly. To our knowledge intentional resection of the diaphragm during laparoscopic radical nephrectomy for large renal tumors has not yet been described. We detail the laparoscopic management of diaphragmatic resection. Materials and Methods: From March 1996 to February 2001, 36 patients underwent cytoreductive laparoscopic radical nephrectomy at our institution in preparation for systemic immunotherapy. Charts and operative tapes were reviewed and cases were identified in which diaphragmatic resection was performed for locally invasive tumors. Results: In 3 patients a portion of the diaphragm was dissected via laparoscopy during debulking nephrectomy. All patients had renal cell carcinoma with documented metastatic disease. The diaphragm was repaired laparoscopically using intracorporeal suturing techniques in 2 of the 3 patients and a chest tube was placed in all 3. Transient systolic hypotension and hypercarbia in 1 case resolved with manual ventilation. The chest tube was removed on postoperative days 2 to 4. There were no complications and no ipsilateral pleural metastasis was identified at an average of 6 weeks (range 2 to 23) of followup. Conclusions: A portion of the diaphragm may be intentionally resected during laparoscopic radical nephrectomy. This maneuver may be successfully managed without conversion to an open procedure. In cases of a large diaphragmatic defect or the potential for coagulopathy postoperatively a chest tube should be inserted. Potential invasion of the diaphragm by large tumors should not be considered a contraindication to cytoreductive laparoscopic radical nephrectomy.

AB - Purpose: Laparoscopic radical nephrectomy is being performed more commonly. To our knowledge intentional resection of the diaphragm during laparoscopic radical nephrectomy for large renal tumors has not yet been described. We detail the laparoscopic management of diaphragmatic resection. Materials and Methods: From March 1996 to February 2001, 36 patients underwent cytoreductive laparoscopic radical nephrectomy at our institution in preparation for systemic immunotherapy. Charts and operative tapes were reviewed and cases were identified in which diaphragmatic resection was performed for locally invasive tumors. Results: In 3 patients a portion of the diaphragm was dissected via laparoscopy during debulking nephrectomy. All patients had renal cell carcinoma with documented metastatic disease. The diaphragm was repaired laparoscopically using intracorporeal suturing techniques in 2 of the 3 patients and a chest tube was placed in all 3. Transient systolic hypotension and hypercarbia in 1 case resolved with manual ventilation. The chest tube was removed on postoperative days 2 to 4. There were no complications and no ipsilateral pleural metastasis was identified at an average of 6 weeks (range 2 to 23) of followup. Conclusions: A portion of the diaphragm may be intentionally resected during laparoscopic radical nephrectomy. This maneuver may be successfully managed without conversion to an open procedure. In cases of a large diaphragmatic defect or the potential for coagulopathy postoperatively a chest tube should be inserted. Potential invasion of the diaphragm by large tumors should not be considered a contraindication to cytoreductive laparoscopic radical nephrectomy.

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