Recommended
More Related Content
What's hot
What's hot (18)
Similar to Open nss vs lap 2
Similar to Open nss vs lap 2 (20)
More from Ahmed Eliwa
More from Ahmed Eliwa (20)
Recently uploaded
Recently uploaded (20)
Open nss vs lap 2
- 1. Partial nephrectomy for SRM
- 2. Open partial nephrectomy • Open partial nephrectomy is the gold standard approach for SRM.
- 3. functional &Oncological outcome • Lap.Vs open partial nephrectomy - Gill IS,Matin,Desai, et al;J Urol. 2003 - 200 cases( 100 in each arm.)
- 4. Lap.Vs open partial nephrectomy Item Lap. Open P value No. of pts. 100 100 Med. Tumor size. 2.8 cm 3.3 cm 0.005 Solitary kidney 7 28 0.001 Central tumor 35% 33% 0.83 Med.Preop. Creatinine 1.0 mg/dL 1.0 mg/dL
- 5. Lap.Vs open partial nephrectomy Item Lap. Open P value Warm ischemia time 28 min 18 min < 0.001 Intraop. Comp. 5% 0% 0.02 + surgical margin 3 0 0.11
- 6. Lap.Vs open partial nephrectomy • Despite the tumor size was significantly larger in open group, the ischemia time was highly significant shorter in the open group . • The intraoperative complication was nil in the open group.
- 8. functional &Oncological outcome • It shows significant prolonged ischemia time in lap groups (p<0.0001) • Significant more post operative complication . p<0.001 • Although the operative time was less in lap groups, but it the open group show significant difference in the percent of high risk pts (tumor size, site, single kidney)p<0.001
- 10. functional &Oncological outcome • Although comparable outcome ,but ischemia time was significant longer • An important points is the learning curve which was too long • In the non-experienced hands the result will be worse in the lap groups
- 11. Learning curve • The lap NSS is difficult procedure to master and need long time learning curve. • It should be for exophytic non hilar lesion.
- 12. Hilar tumor Increase complication rate with up to 50% of pts have urinary leak and up to 7% of pts have positive surgical margin. Venkatesh et al 2005
- 13. Solitary kidney In solitary kidney: The GFR decreased by 21% and 28% in the open and laparoscopic groups, respectively (P = 0.24).
- 14. Solitary kidney • Postoperative dialysis was required acutely in 0.6% of OPNs versus 10% of LPN (P = 0.01) • Dialysis-dependent end-stage renal failure within 1 year occurred in 0.6% of OPN versus 6.6% of LPNs (P = 0.06).
- 15. LAP limitation - LAP is contraindicated in : I. Ischemic heart disease II. End stage respiratory disease III. Significant renal dysfunction IV. Severe un corrected hypovolaemia Burns EM et al 2010
- 16. LAP limitation - LAP is contraindicated in : I. Uncorrected coagulopathy II. Intestinal obstruction III. Massive haemopretoneum IV. Peritonitis and malignant ascites. Burns EM et al 2010
- 17. LAP limitation - LAP is relatively contraindicated in : I. pregnancy II. Morbid obesity III. Previous renal surgery IV. Organomegaly Burns EM et al 2010
- 18. • The 2D vision: • The lack of depth perception is a significant sensory loss for the surgeon. • The learning curve is long. • The 3D version is limited due to cost.
- 20. Why open? Why not lap? • It has the best oncologic and functional outcome. • It is the best choice in more complex tumor. • The ischemia time was lower than lap. • It overly the difficulties encountered in any lap surgery.