Reduced port laparoscopic radical nephrectomy using an umbilical zigzag skin incision for renal cell carcinoma
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CASE REPORT
Reduced port laparoscopic radical nephrectomy using an umbilical zigzag skin incision for renal cell carcinoma Go Kaneko1 · Suguru Shirotake1 · Kent Kanao1 · Masafumi Oyama1 Received: 2 May 2020 / Accepted: 15 June 2020 © The Japan Society of Clinical Oncology 2020
Abstract Reduced port laparoscopic radical nephrectomy (RPLRN) is an equivalent approach to conventional laparoscopic radical nephrectomy (LRN). In LRN, one wound generally needs to be extended for specimen extraction; therefore, some ingenuity is needed to achieve a good cosmetic outcome. We herein describe our initial experience of RPLRN using an umbilical zigzag skin incision for renal cell carcinoma (RCC). A 64-year-old female [body mass index (BMI): 20.0 kg/m 2] was diagnosed with right RCC, which was 35 mm in diameter (clinical T1aN0M0). Case 2: a 68-year-old male (BMI: 23.2 kg/m2) was diagnosed with right RCC, which was 58 mm in diameter (clinical T1bN0M1), and perinephric fat was relatively thick. The procedure was safely completed in both cases. Total operative times, pneumoperitoneal times, and estimated blood loss in Case 1 and 2 were 90 and 145 min, 49 and 90 min, and 5 and 80 ml, respectively, and the times required to construct umbilical ports and close umbilical wounds were 8 and 9 min and 33 and 46 min, respectively. In Case 1, the specimen was easily extracted without the extension of the umbilical skin incision, whereas it was extended by an additional 2 cm in Case 2. The umbilical wound was inconspicuous in both cases. RPLRN using an umbilical zigzag skin incision for RCC was safely performed without complications, and clashing between instruments was minimized. The high level of cosmesis is advantageous and an umbilical zigzag skin incision may contribute to more widespread use of RPLRN for RCC; however, further studies on long-term oncological outcomes are needed. Keywords Laparoscope · Radical nephrectomy · Renal cell carcinoma · Reduced port surgery · Umbilical zigzag skin incision
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13691-020-00426-2) contains supplementary material, which is available to authorized users. * Go Kaneko [email protected]‑med.ac.jp Suguru Shirotake [email protected]‑med.ac.jp Kent Kanao [email protected]‑med.ac.jp Masafumi Oyama [email protected]‑med.ac.jp 1
Department of Uro‑Oncology, Saitama Medical University International Medical Center, 1397‑1 Yamane, Hidaka, Saitama 350‑1298, Japan
Laparoscopic radical nephrectomy (LRN) was initially reported by Clayman et al. [1], and has since become the gold standard for clinical T2 renal cell carcinoma (RCC) and localized masses not treatable by partial nephrectomy [2]. To further reduce morbidity and improve cosmetic outcomes, laparoendoscopic single-site radical nephrectomy (LESS-RN) and reduced port laparoscopic radical nephrectomy (RPLRN) have been introduced [3, 4]. And LESS-RN and RPLRN have been reported as feasible and safe surgical options for localized RCC th
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