Abstract
Background: The left upper quadrant of the abdomen may be occupied by a wide range of urologic pathology. When these lesions are large, safely resecting them often presents a significant technical challenge, with the possibility of resultant morbidity and mortality. Objective: We describe a technique derived from our experience with multivisceral transplant and organ procurement, which provides excellent exposure of this anatomic region. Design, setting, and participants: From May 1999 to April 2006, 70 patients underwent en bloc mobilization of the spleen and the pancreas and, as necessary, the stomach for masses in the left upper retroperitoneum. Pathology included malignant and benign lesions, including renal cell carcinoma (RCC) with or without inferior vena cava (IVC) involvement, adrenal tumors, retrocrural lymphadenopathy from testicular cancer, and transitional cell carcinoma of the renal pelvis. Surgical procedure: An extended subcostal transabdominal approach was used to resect large tumors in the left upper abdomen. This approach offers significant advantages over conventional approaches, including a flank, thoracoabdominal, or midline transabdominal incision with reflection of the descending colon. Measurements: Intraoperative variables, including operative time, blood loss, transfusion rate, and extent of mobilization were recorded. Postoperative complications, including prolonged intubation, ileus, and deep venous thrombosis were also noted. Results and limitations: Mean estimated blood loss during surgery was 973 ml. There were no perioperative deaths. No patients had pancreatitis or acute renal failure. Deep venous thrombosis was not seen. Cardiopulmonary bypass was used in one patient with an atrial thrombus. At a median follow-up of 42 mo, two patients died due to metastasis. Conclusions: Techniques acquired from organ harvesting as well as our experience at multivisceral transplant, such as en bloc mobilization of the spleen, pancreas, and stomach, can be utilized safely and effectively to gain excellent exposure to the left upper retroperitoneum via an extended subcostal incision with no additional morbidity for the patient.
| Original language | English |
|---|---|
| Pages (from-to) | 1106-1111 |
| Number of pages | 6 |
| Journal | European Urology |
| Volume | 55 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 1 2009 |
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Keywords
- En bloc mobilization
- Transplantation
- Urological tumors
ASJC Scopus subject areas
- Urology
Cite this
En Bloc Mobilization of the Pancreas and Spleen to Facilitate Resection of Large Tumors, Primarily Renal and Adrenal, in the Left Upper Quadrant of the Abdomen : Techniques Derived from Multivisceral Transplantation. / Ciancio, Gaetano; Vaidya, Anil; Shirodkar, Samir; Manoharan, Murugesan; Hakky, Tariq; Soloway, Mark.
In: European Urology, Vol. 55, No. 5, 01.05.2009, p. 1106-1111.Research output: Contribution to journal › Article
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TY - JOUR
T1 - En Bloc Mobilization of the Pancreas and Spleen to Facilitate Resection of Large Tumors, Primarily Renal and Adrenal, in the Left Upper Quadrant of the Abdomen
T2 - Techniques Derived from Multivisceral Transplantation
AU - Ciancio, Gaetano
AU - Vaidya, Anil
AU - Shirodkar, Samir
AU - Manoharan, Murugesan
AU - Hakky, Tariq
AU - Soloway, Mark
PY - 2009/5/1
Y1 - 2009/5/1
N2 - Background: The left upper quadrant of the abdomen may be occupied by a wide range of urologic pathology. When these lesions are large, safely resecting them often presents a significant technical challenge, with the possibility of resultant morbidity and mortality. Objective: We describe a technique derived from our experience with multivisceral transplant and organ procurement, which provides excellent exposure of this anatomic region. Design, setting, and participants: From May 1999 to April 2006, 70 patients underwent en bloc mobilization of the spleen and the pancreas and, as necessary, the stomach for masses in the left upper retroperitoneum. Pathology included malignant and benign lesions, including renal cell carcinoma (RCC) with or without inferior vena cava (IVC) involvement, adrenal tumors, retrocrural lymphadenopathy from testicular cancer, and transitional cell carcinoma of the renal pelvis. Surgical procedure: An extended subcostal transabdominal approach was used to resect large tumors in the left upper abdomen. This approach offers significant advantages over conventional approaches, including a flank, thoracoabdominal, or midline transabdominal incision with reflection of the descending colon. Measurements: Intraoperative variables, including operative time, blood loss, transfusion rate, and extent of mobilization were recorded. Postoperative complications, including prolonged intubation, ileus, and deep venous thrombosis were also noted. Results and limitations: Mean estimated blood loss during surgery was 973 ml. There were no perioperative deaths. No patients had pancreatitis or acute renal failure. Deep venous thrombosis was not seen. Cardiopulmonary bypass was used in one patient with an atrial thrombus. At a median follow-up of 42 mo, two patients died due to metastasis. Conclusions: Techniques acquired from organ harvesting as well as our experience at multivisceral transplant, such as en bloc mobilization of the spleen, pancreas, and stomach, can be utilized safely and effectively to gain excellent exposure to the left upper retroperitoneum via an extended subcostal incision with no additional morbidity for the patient.
AB - Background: The left upper quadrant of the abdomen may be occupied by a wide range of urologic pathology. When these lesions are large, safely resecting them often presents a significant technical challenge, with the possibility of resultant morbidity and mortality. Objective: We describe a technique derived from our experience with multivisceral transplant and organ procurement, which provides excellent exposure of this anatomic region. Design, setting, and participants: From May 1999 to April 2006, 70 patients underwent en bloc mobilization of the spleen and the pancreas and, as necessary, the stomach for masses in the left upper retroperitoneum. Pathology included malignant and benign lesions, including renal cell carcinoma (RCC) with or without inferior vena cava (IVC) involvement, adrenal tumors, retrocrural lymphadenopathy from testicular cancer, and transitional cell carcinoma of the renal pelvis. Surgical procedure: An extended subcostal transabdominal approach was used to resect large tumors in the left upper abdomen. This approach offers significant advantages over conventional approaches, including a flank, thoracoabdominal, or midline transabdominal incision with reflection of the descending colon. Measurements: Intraoperative variables, including operative time, blood loss, transfusion rate, and extent of mobilization were recorded. Postoperative complications, including prolonged intubation, ileus, and deep venous thrombosis were also noted. Results and limitations: Mean estimated blood loss during surgery was 973 ml. There were no perioperative deaths. No patients had pancreatitis or acute renal failure. Deep venous thrombosis was not seen. Cardiopulmonary bypass was used in one patient with an atrial thrombus. At a median follow-up of 42 mo, two patients died due to metastasis. Conclusions: Techniques acquired from organ harvesting as well as our experience at multivisceral transplant, such as en bloc mobilization of the spleen, pancreas, and stomach, can be utilized safely and effectively to gain excellent exposure to the left upper retroperitoneum via an extended subcostal incision with no additional morbidity for the patient.
KW - En bloc mobilization
KW - Transplantation
KW - Urological tumors
UR - http://www.scopus.com/inward/record.url?scp=62649163224&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=62649163224&partnerID=8YFLogxK
U2 - 10.1016/j.eururo.2008.12.038
DO - 10.1016/j.eururo.2008.12.038
M3 - Article
VL - 55
SP - 1106
EP - 1111
JO - European Urology
JF - European Urology
SN - 0302-2838
IS - 5
ER -