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Annals of Surgical Oncology

, Volume 19, Issue 2, pp 693–693 | Cite as

Laparoscopic Left Nephrectomy with “En Bloc” Distal Splenopancreatectomy

  • Cristiano Germano HuscherEmail author
  • Andrea Mingoli
  • Giovanna Sgarzini
  • Andrea Mereu
Urologic Oncology

Abstract

Background

Multiorgan resection for cancer is considered a demanding laparoscopic procedure. We report a laparoscopic radical nephrectomy and distal splenopancreatectomy for a locally advanced kidney tumor.

Methods

A 67-year-old woman presented with left flank pain and hematuria. CT scan showed a left kidney upper pole large mass with direct extension to spleen and pancreatic tail, but not metastases. With the patient on the right flank, three 10-mm trocars were placed forming an isosceles triangle in the left subcostal arch. Entering the lesser sac, splenic vessels were separately divided between clips. The pancreatic tail was dissected free and divided with Ultracision. The left renal vein was dissected free, and the aorta was exposed to perform the lymphadenectomy. Superior mesenteric artery and left renal vein and artery were isolated, and renal vessels were separately divided with a vascular stapler. The left kidney was mobilized. The specimen was inserted in a bag and retrieved transvaginally through a posterior colpotomy.

Results

Total operation time was 210 minutes. Estimated blood loss was 250 mL. The patient was discharged after 7 days. Final stage of disease was pT4N0M0 G2 R0 renal cell carcinoma. The patient came back 6 years later presenting a ductal adenocarcinoma of pancreatic head. At the second look laparoscopy, very few adhesions were found in right upper quadrant, and the posterior colpotomy scar was very small. The patient died 1 year after Whipple operation.

Conclusions

Oncologic rules of an “en bloc” resection can be respected also with a laparoscopic approach.

Keywords

Superior Mesenteric Artery Renal Vein Pancreatic Head Estimate Blood Loss Left Kidney 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Supplementary material 1 (MPG 97921 kb)

Copyright information

© Society of Surgical Oncology 2011

Authors and Affiliations

  • Cristiano Germano Huscher
    • 1
    Email author
  • Andrea Mingoli
    • 2
  • Giovanna Sgarzini
    • 3
  • Andrea Mereu
    • 3
  1. 1.SurgeryUniversity of MoliseIserniaItaly
  2. 2.Surgery P. ValdoniLa Sapienza UniversityRomeItaly
  3. 3.General SurgerySan Giovanni HospitalRomeItaly

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