Nephrectomy

Purpose To identify preoperative factors associated with surgical complications and successful diagnostic renal biopsy in both laparoscopic and percutaneous radiofrequency ablation (RFA) of renal masses in order to help aid in preoperative patient counseling for renal RFA. Methods We reviewed our Institutional Review Board approved database from November 2001 to January 2011, containing 335 tumors treated with either laparoscopic (LRFA) or percutaneous RFA (CTRFA). Preoperative patient demographics, tumor characteristics, and intraoperative surgical data were collected along with biopsy results and clinicopathologic outcomes.

Autosomal dominant polycystic kidney disease an inherited systemic disorder is characterized by the development of multiple cysts in the kidneys and other organs. When nephrectomy is indicated, the laparoscopic approach is challenging due to the massive size of these kidneys. We present our technique and evaluate the surgical outcomes of laparoscopic versus open nephrectomy for patients with such condition. A retrospective review was done for six laparoscopic and six open nephrectomies performed by two laparoscopic surgeons in two university hospitals between January 2004 and December 2004. Preoperative, intraoperative, and postoperative data are presented. A standard subcostal incision was used for the open cases while for the laparoscopic approach a 3-4-port transperitoneal laparoscopic approach was used to dissect the involved kidney, which is then removed intact or morcellated through pfannenstiel, midline, or expanded port site incision. The laparoscopic patients had a longer o...

Today successful kidney transplantation procedures, techniques and immunosuppression protocols are a consequence of extensive research on animal models. During every transplantation surgery there are two crucial points for the success of the entire procedure: vascular (arterial end venous) and ureteral or ureterovesical anastomosis. Renal artery and vein of the donor kidney can be anastomosed end-to-side to the abdominal aorta and vena cava of the recipient (heterotopic transplantation), or end-to-end to the remains of renal artery and vain of the recipient (orthotopic transplantation) after nephrectomy. The ureter can be anastomosed also end-to-end or we can connect it directly to the urinary bladder (ureterocystoneostomy). The aim of this study was to elucidate which technique has better results according to: animal survival, reperfusion and perfusion of the transplanted kidney, elimination of the urine from the transplanted kidney and procedure costs. The study included 240 (120 ...

Purpose: After renal parenchymal sparing surgery, residual defects may persist on imaging studies at the sites of resection. These upseudotumorsn may lead to confusion as to whether a lesion was removed or has recurred. We describe the imaging appearances and behavior of renal pseudotumors following renal parenchymal sparing surgery. Materials and Methods: From 1988 to 1997, 32 patients underwent 46 renal parenchymal sparing surgeries for removal of renal cancers, including von Hippel-Lindau disease in 27, hereditary papillary renal cancer in 2 and sporadic disease in 3. A median of 14 tumors (range 1 to 114) were removed in each operation. Thrombin soaked absorbable gelatin sponge was placed in the tumor bed after resection to aid hemostasis. We reviewed all imaging studies performed after these operations to characterize these lesions and gain further understanding into the prevalence and etiology. Results: Of the patients, 9 had a total 13 pseudotumors on initial postoperative imaging studies, including Hippel-Lindau disease in 7, hereditary papillary renal cancer in 1 and sporadic renal cancer in 1. Pseudotumors were observed after 10 of 46 operations (22%). All pseudotumors demonstrated round contours and enhancement after contrast media, simulating a tumor, yet, these lesions resolved in a mean of 13 months, leaving only small cortical scars. Conclusions: Renal pseudotumors are commonly seen after renal parenchymal sparing surgery and should not be confused with residual or recurrent disease. Enhancement is likely due to granulation tissue involving the lattice of absorbable gelatin sponge. These lesions usually resolve within a year but can take longer to do so.

9 Nephrectomy for Wilms' tumor was performed on 58 patients over a 20-yr period, and retroperitoneal lymphadenectomy was performed on 35 who presented with no demonstrable metastases. The survival rate was 100% for 19 clinical group I patients with negative nodes. Positive nodes in 9 instances led to 5 long-term survivors and significantly influenced staging as a guide for further therapy.

Seit der ersten laparoskopischen Nephrektomie durch Clayman 1990 wurden beinahe alle ablativen und rekonstruktiven operativen Maßnahmen an der Niere auch laparoskopisch durchgeführt. Für die gutartigen Erkrankungen konnte schon früh die Vorteile der Laparoskopie im Vergleich zur offenen Operation nachgewiesen werden. Diese zeigen sich in einem verringerten postoperativen Schmerzmittelkonsum, der kürzeren Hospitalisationsdauer, der kürzeren Rekonvaleszenz und als gut objektivierbare Parameter der geringere Anstieg von Interleukinen und Akute-Phase-Proteinen, als Ausdruck der geringeren Invasivität. In einer Vielzahl von Publikationen ist in den letzten Jahren über die Wertigkeit der Laparoskopie in der Nierenchirurgie bei malignen Erkrankungen berichtet worden. Für die laparoskopische radikale Nephrektomie beim Nierenzellkarzinom und auch aus einigen Zentren für die laparoskopische Nierenteilresektion konnte eine Gleichwertigkeit zu den offen operativen Verfahren bezüglich des onkologischen Outcomes nachgewiesen werden, mit allen Vorteilen der minimal-invasiven Techniken. Neben der ständigen Weiterentwicklung der Technik ist die Verbreitung der Methode eine der wichtigen gegenwärtigen und zukünftigen Aufgaben. Since the first laparoscopic nephrectomy in 1990, most ablative and reconstructive urological kidney surgery has been attempted laparoscopically. The advantages of this method were first demonstrated for benign diseases, with less postoperative pain, shorter hospitalization, faster convalescence and, for the objective evaluation of these findings, with lower serum levels of interleukins and acute phase proteins, and without disadvantages in therapy efficiency. Over the last few years, sufficient data have been published to show the oncological outcome for patients with kidney cancer. For laparoscopic radical nephrectomy, and recently also for partial nephrectomy, oncological equality with open procedures could be demonstrated, with all of the benefits of minimally invasive techniques. The use of laparoscopy was one of the most important steps in the progress of medicine in the 20th century. Our aims include the further improvement of this technique and its distribution to surgical centers.

What ' s known on the subject? and What does the study add? Robotic partial nephrectomy has equivalent oncological outcomes, and possibly better functional outcomes in the short-to-intermediate term, when compared to laparoscopic partial nephrectomy. Robotic partial nephrectomy has a less prohibitive learning curve, better ergonomics, and improved vision when compared to laparoscopic partial nephrectomy. We describe our standard transperitoneal technique for robotic partial nephrectomy and also highlight the essential steps in an accompanying video. Novel approaches are discussed, including robotic bulldog clamps for hilar clamping, robotic ultrasound probe for tumour identifi cation, fl exible Doppler probe for vessel identifi cation, and barbed suture renorrhaphy. Tips and tricks to avoid common pitfalls and manage complications are discussed.

A 17-year-old boy presented for evaluation of an abdominal mass. Imaging revealed a 12.5-cm left upper pole renal mass. Biopsy demonstrated a malignant neoplasm consistent with blastemal-type Wilms tumor. The patient received neoadjuvant chemotherapy followed by laparoscopic radical nephrectomy. Examination revealed an unremarkable kidney uninvolved by tumor abutted by a 7.3 cm encapsulated mass. Histology revealed a triphasic Wilms tumor (nephroblastoma) with favorable histology. This tumor was classified as a juxtarenal Wilms tumor, a rare form of extrarenal Wilms tumor, with only 7 cases described in the literature. We present the first case of a juxtarenal Wilms tumor described in an adolescent. UROLOGY 80: 922-924, 2012.

Resultats. -La durée totale d'intervention, le temps d'ischémie chaude et le saignement global (per-et postopératoire) étaient en moyenne de 108 minutes (70-140 minutes), 38 minutes (22-50 minutes) et 95 ml (10-300 ml), respectivement. L'analyse de régression statistique retrouvait une corrélation directe entre le nombre de cas effectués et le saignement peropératoire (p < 0,001), ainsi que le temps d'ischémie chaude (p < 0,001). À partir du cas n • 10, ces paramètres étaient stabilisés. Il y a eu deux fuites d'urines à j10 sur 40 interventions sans corrélation avec le nombre de cas effectués. Conclusion. -Le temps opératoire et la durée d'ischémie chaude ont été directement corrélés au nombre de cas effectués. Un entraînement sur un modèle porcin nous a semblé être un bon moyen de réduire la courbe d'apprentissage chez l'homme. Dix interventions ont été nécessaires pour acquérir les différents temps opératoires.

C index ϭ centrality index CT ϭ computerized tomography EBL ϭ estimated blood loss IOC ϭ intraoperative complication incidence IOV ϭ interobserver variability LPN ϭ laparoscopic partial nephrectomy ORT ϭ operative time POC ϭ postoperative complication incidence WIT ϭ warm ischemia time

The foundations of the generally accepted principles underlying the surgical management of renal cell carcinoma (RCC) were best annunciated in 1969 by Robson in his classic description of the radical nephrectomy [J Urol 1969;101;297]. Since then, much has changed in our understanding of the basic biology and genetics of kidney cancer, advances in renal imaging and clinical staging have led to the increased detection of incidental, lower stage, organ-confined tumors more amendable to expanded surgical options, surgical techniques themselves have evolved, and surgical equipment technology has advanced to make possible new methods of managing renal tumors in situ. Thus, the management of both localized and metastatic RCC has changed dramatically in the last 20 years, predicated on these major advancements in renal imaging, surgical techniques, and the development of effective immunotherapies for advanced disease. In this review, the evolution in thinking regarding the tenets of the radical nephrectomy will be examined, including the necessity for removal of the entire kidney, the possibility of sparing the adrenal gland, when and how extensive a lymphadenectomy should be performed, the development of laparoscopic and percutaneous nephron-sparing surgery using ablative technologies, and the role of nephrectomy and metastasectomy in patients with metastatic RCC. Here, we review current concepts and outcomes on the surgical management of RCC to help elucidate some of these changes, from the evolution of open to laparoscopic to percutaneous, from radical to partial to ablative approaches. #

Wilms tumor is the most common renal malignancy in children. In the 1930s, overall survival for children with Wilms tumor was approximately 30%. Use of multidisciplinary therapy, guided by results from multiinstitutional, randomized trials, has substantially improved overall survival to about 90%. Management of Wilms tumor differs substantially between Europe and the US. In Europe, the International Society of Pediatric Oncology protocols call for management of patients with presumptive Wilms tumor with neoadjuvant chemotherapy followed by nephrectomy and further chemotherapy. In the US, protocols developed by the National Wilms Tumor Study Group advise primary nephrectomy followed by a chemotherapy regimen tailored to the pathologic tumor stage. Despite these disparate strategies, overall survival is similar in patients managed according to European and US protocols. Patients with Wilms tumor now have excellent survival. Therefore, current goals aim to reduce the morbidity associated with therapy. Important complications of treatment for Wilms tumor include cardiomyopathy, renal failure, and increased risk of a secondary malignancy. Currently, the role of laparoscopic surgery in management of Wilms tumor remains extremely limited.

Aluminum toxicity is the presumed cause of aluminum-associated osteomalacia. In animal models, osteomalacia has been produced after a prolonged course of aluminum. In the present study, rats with renal failure received 20 mg intraperitoneal aluminum during a 2 day period. This model allows sequential observations in the development of osteomalacia. Rats were sacrificed and studied 5, 12, 25, and 40 days after aluminum administration. No differences were observed in serum calcium, phosphorus, or creatinine as a consequence of aluminum administration. Compared with control rats, parathyroid hormone was decreased at 12 and 25 days. A direct correlation was present between plasma and bone aluminum at 12 days (r = 0.92, p < 0.01), 25 days (r = 0.85, p < 0.005), and 40 days (r = 0.88, p < 0.001) but not 5 days after aluminum administration. Plasma aluminum peaked at 5 days (727 ± 89 μg/liter, mean ± SEM) and bone aluminum at 40 days (273 ± 40 μg/g). Aluminum had profound effect on bone histology. At 5 days there was a decrease in osteoblast surface and osteoid surface; at 12 days osteoblast surface and osteoid surface returned to normal but osteoclast surface decreased. Subsequently there was a progressive increase in osteoid surface and osteoid volume. Bone formation rate measured at 12, 25, and 40 days was decreased at these intervals.In conclusion, (1) high plasma aluminum may be directly toxic to the osteoblast; (2) progressive osteoid accumulation is secondary to matrix (osteoid) deposition, which exceeds the depressed bone formation rate; (3) the progressive decrease in plasma aluminum and increase in bone aluminum suggest that bone has a high affinity for aluminum but may have a relatively slow rate of uptake at any given time; (4) aluminum may directly decrease parathyroid hormone; (5) the correlation between plasma and bone aluminum suggest an exchange is present; and (6) aluminum toxicity may independently affect the osteoblast and bone mineralization.

Medullary sponge kidney (MSK) is an uncommon benign congenital disorder, generally asymptomatic. In symptomatic patients the diagnosis is usually made by excretory urography performed in the most frequent complications such as renal stones, urinary tract infections and haematuria. Excretory urography can be very characteristic, showing cystic collections of ectatic collecting ducts like &quot;bunches of grapes&quot; or &quot;bouquet of flowers&quot;. When haematuria represents the only symptom, and radiographic findings are not characteristic of MSK, the differential diagnosis with a renal tumor can be very difficult. We report a case of MSK that underwent nephrectomy since clinical and radiological features mimicked a renal tumor.

Evaluation of the risk for developing renal insufficiency is generally not considered during the clinical metabolic workup of the stone-forming patient. This review approaches the problem of the severity of nephrolithiasis by addressing the renal risk. Although renal stones are an infrequent cause of renal failure, some lithiasic forms present a greater risk, such as in hereditary stone diseases (eg, cystinuria, primary hyperoxaluria, Dent's disease), primary struvite stones, and infection-related urolithiasis associated with anatomic and functional urinary tract anomalies and spinal cord injury. Recurrent bouts of obstruction and/or crystal-specific biological effects on tubular epithelial cells and interstitial renal cells may activate the fibrogenic cascade responsible for the loss of renal parenchyma. In clinical terms, frequent stone relapses, episodes of urinary tract infection and obstruction, number of urological interventions, and size of the gravel are all significantly associated with the risk for renal failure. Percutaneous and extracorporeal urological methods for the treatment of renal stones may also lead to some chronic deterioration of renal function, particularly in recurrent stone formers treated with multiple therapeutic sessions. Although still speculative, concerns exist about the effect of extracorporeal shock wave lithotripsy on small or pathological kidneys. Without doubt, the medical prevention of stones would be more sensible.

Purpose: Renal oncocytosis is a rare pathological condition in which renal parenchyma is diffusely involved by numerous oncocytic nodules in addition to showing a spectrum of other oncocytic changes. We describe our experience with renal oncocytosis, focusing on management and outcomes. Materials and Methods: A total of 20 patients with a final pathological diagnosis of renal oncocytosis from July 1995 through June 2009 were included in the analysis. Patient demographics, intraoperative variables and postoperative outcomes are reported. Results: Median age at nephrectomy was 71 years (IQR 59 -75). Of the patients 15 (75%) had bilateral disease. There were 23 operations (9 right side, 14 left side) performed on 20 patients, and of these procedures 13 (57%) were partial nephrectomies and 10 (43%) were radical nephrectomies. Median dominant tumor mass diameter was 4.1 cm (IQR 3-6.4, range 1 to 14.6). The most common dominant tumor histology was hybrid tumor between oncocytoma and chromophobe renal cell carcinoma in 13 of 23 specimens (57%), followed by chromophobe renal cell carcinoma in 6 (26%), oncocytoma in 3 (13%) and conventional renal cell carcinoma in 1 (4%). Ten patients (50%) had preexisting chronic kidney disease before nephrectomy and chronic kidney disease developed in 5 more after surgery. After a median followup of 35 months no patients had metastatic disease. Conclusions: Patients with renal oncocytosis usually present with multiple and bilateral renal nodules. Half of the patients had chronic kidney disease at diagnosis and 25% had new onset of chronic kidney disease. No patient had distant metastatic disease during followup. Our management approach is to perform partial nephrectomy when possible and then use careful surveillance of the remaining renal masses.

We recently showed that the bradykinin B2 receptor (B2R) blocker icatibant (Icat) and the peroxisome proliferatoractivated receptor-g agonist rosiglitazone (Ros) exerted anti-inflammatory effects in renal tubular cells exposed to a diabetic milieu. This study aims to explore whether these effects can be translated to an experimental model of type 2 diabetic nephropathy (DN). db/db mice and their nondiabetic db/m littermates underwent sham operation or uninephrectomy (Unx) at 10 weeks and received vehicle (Veh), metformin (Met), Icat, Ros, or Icat plus Ros for 8 weeks before killing. Among the db/db group with Unx, mice that received Icat or Ros had significantly lower serum creatinine and albuminuria, which was further reduced when Icat and Ros were given in combination. These beneficial effects were not observed in the Met group that achieved similar glycemic control as Ros-treated animals. Likewise, the severity of reactive glomerular and proximal tubular hypertrophy, glomerulosclerosis, interstitial injury, cortical F4/80 and a-smooth muscle actin immunostaining, and CCL-2, ICAM-1 and TGF-b overexpression were all attenuated by Icat and Ros, and these effects were enhanced when both agents were combined. Immunohistochemical staining confirmed the proximal tubular expression of CCL-2 (inflammation) and TGF-b (fibrosis). Treatment with Icat was associated with decreased B2R, but increased, B1R expression, which was exaggerated in Unx animals. At the signaling level, Icat and Ros reduced extracellular signal-regulated kinase 1/2 and STAT1 activation, respectively. Our results suggest a deleterious role of the kallikrein-kinin system in murine-accelerated DN, which can be ameliorated by the B2R blocker Icat and enhanced by the addition of Ros. This calls for further evaluation of this novel therapeutic approach in more animal models of diabetic nephropathy.

A laboratory based study was carried out with the objective to isolate the bacteria causing UTI in kidney transplanted and other UTI suspected patients and find out their antibiotic susceptibility pattern. A total of 1233 urine samples (439 urine samples from kidney transplanted patients) were collected and subjected to laboratory analysis and culture. The prevalence of uropathogens was found to be 14.19% (175/1233). Out of total 175 isolates of uropathogens, 16 different bacterial species were identified, of which 94.29% (165/175) gram negative bacteria were belonging to 12 different species. In gram negative the most predominant was Escherichia coli (64.14%), followed by Klebsiella pneumoniae (12.57%), Klebsiella oxytoca (5.14%), Acinetobacter spp. and Pseudomonas aeruginosa (3.43%). Out of total, 439 urine samples from Kidney transplanted patients, only 22 samples (5.01%) had showed significant growth. The most efficient first line antibiotics for isolates was found to be Ceftriaxone 68.57%, followed by Nitrofurantoin 60% and in second line antibiotics Ceftazidime-clavunic acid and Amikacin showed susceptibility of 89.55%. Out of 175 uropathogens, 48% (84/175) isolates were found to be MDR positive. In gram negative bacteria, E. coli showed highest percentage of MDR that is 53.27%. Association of significant bacteriuria and gender of patients was found to be statistically significant (p<0.05). Transplantation status and infection status were found to have strong association (p<0.001).

Objectives. To evaluate the feasibility of laparoscopic partial nephrectomy assisted by a water-cooled, high-density, monopolar device (TissueLink Floating Ball). Methods. Transperitoneal laparoscopic partial nephrectomy was performed without vascular control for four renal tumors in 3 patients. A flexible ultrasound probe was used to confirm tumor location and depth. Gerota's fascia was opened distant from the tumor site. Renal fat was dissected from the renal parenchyma except for the fat overlying the tumor. The tumor resection area was marked 1 cm outside the boundaries of the tumor. After application of the TissueLink Floating Ball at the planned surgical margin, the tumor was resected with cold laparoscopic scissors. Bleeding from the vessels of the divided renal parenchyma was controlled with the Floating Ball if necessary. The specimen was sent for frozen section to confirm margin status. Results. Mean estimated blood loss per tumor was 275 mL. The dissection extended to the collecting system in 2 of 4 cases. In 1 patient, a minor postoperative urine leak resolved spontaneously. Conclusions. Use of the TissueLink Floating Ball facilitated resection of small renal tumors without renal vascular control. Although further study is necessary, water-cooled, high-density monopolar energy may have a role in laparoscopic partial nephrectomy. UROLOGY 61: 906-909, 2003.

E U R O P E A N U R O L O G Y X X X ( 2 0 1 0 ) X X X -X X X a v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j o u r n a l h o m e p a g e : w w w . e u r o p e a n u r o l o g y . c o m Abstract Context: Laparoscopic living-donor nephrectomy (LLDN) has achieved a permanent place in renal transplantation and in some centers has replaced open donor nephrectomy as the standard technique. Objective: To evaluate the published literature regarding the relative results and complications of open LLDN and the hybrid technique of hand-assisted LLDN.

Voor mijn ouders, mijn broertje, Mayke, en niet te vergeten alle ratten die onvrijwillig hun leven ter beschikking hebben gesteld voor deze studies In the time of your life, live -so that in good time there shall be no ugliness or death for yourself or for any life your life touches.

The aim of this study was to investigate the effect of increased number and frequency of vaccination on immune complex deposition in the choroid plexus and glomeruli of non-nephrectomized and unilateral nephrectomized mice. Fifty-five non-nephrectomized, 40 nephrectomized, and 7 control Swiss albino mice were used. Half of each group was vaccinated only with diphtheria-tetanus and the other half with multiple vaccines, which are used in pediatric practice. Each group was divided into subgroups, which were vaccinated with increasing frequency. No immune deposits were detected in the choroid plexus of any vaccinated mice. There were immune deposits in glomeruli in 2 of 55 (3.6%) of the non-nephrectomized and in 3 of 40 (7.5%) of the nephrectomized mice (P=0.199). The difference between the diphtheria-tetanus and multiple vaccine groups in non-nephrectomized (P=0.236) and nephrectomized (P=1.000) mice was not significant. A significant positive correlation between increased frequency of vaccination and glomerular immune complex deposition 8 weeks after the last immunization was detected in the multiple vaccine group of nephrectomized mice (P=0.048, r=0.447). Our results suggest that the large number and frequent doses of vaccines would not lead to immune complex deposition in choroid plexus and do not significantly increase the deposition of immune complexes in glomeruli in unilateral nephrectomized mice compared with non-nephrectomized mice.

Purpose: Laparoscopic live donor nephrectomy has acquired an important role in the era of minimally invasive surgery. Laparoscopic harvesting of the right kidney is technically more challenging than that of the left kidney because of the short right renal vein and the need to retract the liver away from the right kidney. The aim of this article is to report our experience with right laparoscopic live donor nephrectomies.

We report a case of a 74-year-old woman exhibiting the yellow nail syndrome in association with ipsilateral xanthogranulomatous pyelonephritis. Nephrectomy resulted in complete resolution of the pleural effusion and slow improvement of the yellow nails. This report calls attention to the renal-related pleural effusion, and to the thorough investigation needed for the yellow nail syndrome.

Malignant hypertension is a well-defined condition associated with high blood pressure and acute target-organ damage. Although 95% of cases are secondary to essential hypertension, its etiological profile is broad. Juxtaglomerular cell tumor is a rare condition, with only approximately 65 cases reported to date. We describe a patient with malignant hypertension with acute renal failure and intestinal ischemia secondary to a juxtaglomerular cell tumor. We believe this is the first case of juxtaglomerular cell tumor causing malignant hypertension. The diagnostic approach and treatment are discussed. Am J Kidney Dis 46:957-961.

Purpose: We report our initial experience with laparoscopy-and robot-assisted partial nephrectomy (RAPN) operations. Materials and Methods: Between November 2003 and April 2009, laparoscopic partial nephrectomy (LPN) was performed in 20 patients (hand-assisted procedure in one patient) and RAPN in 11 patients. Transperitoneal approach was used in both groups. Results: The patient demographics were similar in both groups. The groups were statistically comparable for body mass index (BMI), gender, and American Society of Auesthesiologists (ASA) scores. The mean tumor size was 32.1 mm (range 20-41 mm) in the RAPN group and 31.45 mm (range 15-70 mm) in the LPN group. The operative time was 226 minutes (range 120-420) in the LPN group and 185 minutes (range 120-270) in the RAPN group; the difference was not statistically significant ( p ¼ 0.07). The mean warm ischemia time was significantly shorter in the RAPN group (27.3 minutes for the RAPN group and 35.8 for the LPN group) ( p ¼ 0.02). The mean estimated blood loss was 286.4 mL in the RAPN group and 387.5 mL in the LPN group ( p ¼ 0.3). One patient (5%) had focal positive margin in the LPN group. No patient had positive surgical margins in the RAPN group. Conclusions: In this pilot study, we found that RAPN and LPN are feasible and safe operations in T1 renal tumors. The advantages for RAPN are excision of the tumor under three-dimensional vision and easy suturing with the articulated instruments of the robotic system. The cost and the need for two experienced laparoscopic surgeons are the disadvantages of robotic surgery. Larger randomized studies are needed to evaluate whether RAPN has any advantages over LPN.

Purpose: We evaluated the effects of warmed, humidified CO 2 and anti-inflammatory agents on the local and systemic cytokine response after laparoscopic nephrectomy. Materials and Methods: A total of 15 pigs were randomized to undergo standard laparoscopic nephrectomy, laparoscopic nephrectomy with warmed, humidified CO 2 gas or laparoscopic nephrectomy with perioperative administration of intravenous dexamethasone and oral rofecoxib. At baseline, and 1, 4, 24 and 48 hours after surgery duplicate blood and peritoneal samples were drawn to analyze cortisol, glucose, tumor necrosis factor-␣ (TNF-␣), interleukin (IL)-1␤ and IL-6 via a microassay technique. Body temperature was determined at operation, intraoperatively and 1 hour postoperatively. Surgical parameters, including operative time, gas volume used and blood loss, were recorded. Results: Pigs in the warmed, humidified CO 2 and anti-inflammatory arms maintained higher intraoperative and postoperative core body temperatures than controls. Warmed, humidified CO 2 did not affect peritoneal or systemic cytokine levels. Peak peritoneal TNF-␣ levels in the anti-inflammatory group were significantly higher than in controls at 4 hours. Considerably higher serum TNF-␣ levels in the anti-inflammatory group were observed at 48 hours. Peritoneal IL-1␤ and IL-6 levels in the anti-inflammatory group remained similar to those in controls, while serum levels were noticeably lower. There was no observable difference in serum cortisol or the glucose response to laparoscopic nephrectomy among the groups. Conclusions: While preserving core body temperature, humidified, warmed CO 2 did not affect local or systemic trends of pro-inflammatory mediators. The administration of perioperative anti-inflammatory agents produced conflicting local and systemic cytokine response of uncertain clinical significance.

Renal cell carcinoma arising from epithelial cells of the renal tubule is a highly aggressive and malignant tumor in all ages. Less than 2% of cases occur in childhood, relatively in older age group. Only a few pediatric series have been presented in the English literature. Tumor is presented with characteristic findings of flank pain, gross hematuria, and palpable mass. Although one half of the patients have metastasis at the time of diagnosis, most cases are currently being incidentally detected using improved imaging techniques. The overall prognosis in children appears to be similar to that in adults. Tumor stage and complete surgical resection have been reported as the most meaningful prognostic factors for the outcome. The incidence of metastatic disease is same as in adults. The effect of chemotherapy and immunotherapy, either preoperatively or postoperatively, is unclear. Cure is the most likely consequence in localized and completely resected tumors. Here, we present an 8-year-old boy with renal cell carcinoma demonstrating only hematuria without any pathological physical examination findings. The mass was described by abdominal ultrasonography and computed tomography in the left kidney. After the left nephroureterectomy, the patient was given no therapy.