Occlusion Angiography Using Intraoperative Contrast-enhanced Ultrasound Scan (CEUS): A Novel Technique Demonstrating Segmental Renal Blood Supply to Assist Zero-ischaemia Robot-assisted Partial Nephrectomy
In: European urology, Jg. 63 (2013), Heft 5, S. 913-919
academicJournal
- print, 24 ref
Zugriff:
Background: Recent innovations in technology and operative techniques have enabled safe performance of robot-assisted zero-ischaemia partial nephrectomy (PN), thus preventing the deleterious effect of warm ischaemia time. Objective: To describe a novel technique of occlusion angiography using intraoperative contrast-enhanced ultrasound scan (CEUS) for zero-ischaemia robot-assisted PN (RAPN). Design, setting, and participants: We used a prospective cohort evaluation of five patients who had imaging suspicious of renal cell carcinoma (RCC) treated at a single centre. Surgical procedure: We used computed tomography with three-dimensional reconstruction to identify renal arterial anatomy and its relationship to the tumour. Then, RAPN was performed with selective clamping and demonstration of a nonperfused segment of kidney (occlusion angiography) using intraoperative CEUS. Outcome measurements and statistical analysis: We prospectively collected data on baseline, perioperative, and postoperative parameters. Results and limitations: We describe the effects seen on ultrasound contrast administration. Contrast flare is seen in the segment of the kidney that is perfused. When selective clamping is performed, a watershed (line of demarcation) between the perfused and nonperfused segments of the kidney is clearly seen, allowing excision of the tumour in a relatively avascular plane and ensuring an adequate oncologic margin, when feasible. The mean age was 68.2 yr of age (range: 36―85), and the mean tumour size was 29.6 mm (range: 20-42). The mean intraparenchymal extension of the tumour was 22.6 mm (range: 12-30). Three tumours were located on the right kidney and two on the left. The mean blood loss was 420 ml (range: 200-1000). The histology revealed clear cell RCC in two patients, oncocytoma in two patients, and type 1 papillary RCC in one patient. All the surgical specimens had negative surgical margins. The mean decrease in glomerular filtration rate was 8.4 ml (range: 0-24). The mean follow-up was 6.4 mo (range: 5-8), with no evidence of recurrence in any patient. The only limitation in adopting this technique is the need for an intraoperative ultrasound probe with a CEUS mode. However, most specialists who perform minimally invasive surgery for small renal tumours believe that intraoperative ultrasound scan imaging is essential to achieving adequate resection margins. Conclusions: Intraoperative CEUS can be a useful adjunct in determining whether zero-ischaemia RAPN is feasible by delineating the area of nonperfusion. This technique has several advantages over the currently available techniques, such as indigo carmine green and Doppler probes.
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Occlusion Angiography Using Intraoperative Contrast-enhanced Ultrasound Scan (CEUS): A Novel Technique Demonstrating Segmental Renal Blood Supply to Assist Zero-ischaemia Robot-assisted Partial Nephrectomy
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Autor/in / Beteiligte Person: | RAJ RAO, Amrith ; GRAY, Robert ; MAYER, Erik ; MOTIWALA, Hanif ; LANIADO, Marc ; KARIM, Omer |
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Zeitschrift: | European urology, Jg. 63 (2013), Heft 5, S. 913-919 |
Veröffentlichung: | Kidlington: Elsevier, 2013 |
Medientyp: | academicJournal |
Umfang: | print, 24 ref |
ISSN: | 0302-2838 (print) |
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