ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe present review summarizes current developments in the imaging of renal tumors.Recent findingsComputed tomography (CT), magnetic resonance imaging, and ultrasound are used for diagnosing, characterizing, and staging renal tumors. Recent advances have been made in many areas, but the most significant changes have occurred in helical CT. The traditional roles for CT and magnetic resonance imaging have been expanded to include the use of three-dimensional CT and magnetic resonance imaging as surgical planning tools. Three-phase CT scans are commonly performed for detection, characterization, and staging of renal lesions, but pelvic CT is probably not needed for preoperative staging. Three-phase CT scans are more sensitive for characterization and for identifying the renal vasculature. Enhancement characteristics on these scans can help to distinguish between different tumor types. Finally, CT urography is a promising alternative to conventional excretory urography, with the potential to simplify the imaging evaluation of patients with hematuria.SummaryAlthough ultrasound and magnetic resonance imaging have many indications for imaging renal tumors, CT, with new uses and improved diagnostic capabilities, remains the gold standard in renal imaging.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThere is increasing interest in minimally invasive alternatives to surgery, especially as the natural history of small renal masses appears in the majority to be that of very slow growth. Cryoablation and radiofrequency ablation are two energy-based therapies that can be applied in a minimally invasive manner. We will review the recent clinical and laboratory studies that have formed the scientific foundation of the current clinical protocols and how these protocols may change in light of recent observations.Recent findingsAlthough there is literature supporting enhanced cell death with the use of a passive thaw in cryoablation, recent data suggest that the use of an active thaw is no different. The active thaw process will effectively cryoablate renal tissue as well as significantly reduce overall operative time. There is lack of uniformity in the effectiveness of radiofrequency ablation for renal masses. It has been concluded that hematoxylin and eosin staining is inadequate for assessment of cell viability after radiofrequency ablation and thus, nicotinamide adenine dinucleotide staining should be included in the histological assessment of tissue.SummaryCryoablation is the most studied modality and its ability to both directly and indirectly damage cells is generally understood. Clinical experience will further refine knowledge about optimal freezing temperature and freeze-thaw cycles. The coagulation necrosis of radiofrequency ablation is an effective means of destroying cancerous tissue but targeting this energy has been difficult and treatment failures have occurred.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewTraditionally, curative therapy for most renal cancers involved open radical nephrectomy. However, as increased radiological monitoring has led to more incidentally discovered small renal masses, the optimal treatment has evolved. Nephron-sparing surgery, initially developed for patients with solitary kidneys or compromised renal function, emerged as the treatment of choice for small renal masses. It has been shown that long-term cancer control and renal function after partial nephrectomy equals the results of radical nephrectomy. Cryoablation of small renal masses represents an alternative method for performing nephron-sparing surgery.Recent findingsCryoablation of renal tumors with ultrasound monitoring may be performed under open exposure, but laparoscopy provides equivalent exposure with less morbidity. Cryotherapy may also be performed percutaneously with magnetic resonance image monitoring. After treatment, patients require diligent radiographic monitoring, more frequently than after surgical extirpation.SummaryThe durability of renal cryotherapy appears promising. More data are required to provide reliable treatment of tumor margins for larger lesions, and further to determine the safety of use near the collecting system and renal hilum. Currently, cryoablation of small renal lesions is minimally invasive, safe, and efficacious for select peripheral lesions in carefully selected patients.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewEnergy-based tumor ablative techniques are under development for the minimally invasive treatment of renal cell carcinoma. Radiofrequency ablation has recently entered phase II clinical trials for the treatment of small renal tumors. The authors review the status of these clinical trials.Recent findingsRadiofrequency ablation has shown reproducible tumor destruction in both animal models and recent clinical trials. Radiographic follow-up of radiofrequency ablated small renal tumors demonstrates little or no residual contrast enhancement depending on tumor size, location within the kidney, and mode of delivering radiofrequency energy. Pathologic evaluation of ablated tumors shows more variability in outcome, with many tumors demonstrating small areas of viable residual tumor.SummaryRadiofrequency ablation shows promise for the minimally invasive treatment of small renal tumors but will remain experimental until the resolution of certain technical issues.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewBecause an increasing number of small renal cell tumors suitable for nephron sparing surgery are being diagnosed incidentally, the standardization of laparoscopic wedge resection has now become a major issue.Recent findingsIn this article we reviewed mainly recent literature published since November 2001 focusing our interest to clearly present the different techniques for wedge resection. These techniques are shown under two main subtitles: resection with or without ischemia. Also new alternative techniques for resection without ischemia are reviewed.SummaryWedge resection can be done laparoscopically by different techniques. Each technique has its inherent advantages and disadvantages. Further studies and modifications on each technique are expected in the future.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewOpen partial nephrectomy is now recognized as the standard of care for small renal parenchymal tumors. Significant technical problems remain with regard to performing this procedure laparoscopically, namely warm renal ischemia during occlusion of the renal vascular pedicle and renal parenchymal bleeding following tumor excision and release of pedicle control. This article reviews the recent literature in the field of renal parenchymal hemostasis and its role in improving outcomes and increasing applicability for laparoscopic nephron-sparing surgery.Recent findingsTwo themes emerge in reviewing the recent literature on renal hemostasis: the use of increasingly advanced tissue sealants and the use of physical methods. Advances in both areas are covered in this article.SummaryLaparoscopic partial nephrectomy has been developed in an attempt to reduce the morbidity of the open technique. We believe that advances in secure renal parenchymal hemostasis will increase the applicability of the laparoscopic procedure and bring it within the grasp of ordinary urologists.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of reviewThe widespread use of available imaging techniques has resulted in an increased detection of incidental small renal tumors. For these small tumors, there has been a definite trend towards nephron-sparing surgery over the past decade.Recent findingsWith increasing experience, advanced ablative and complex reconstructive procedures are now being performed laparoscopically. Laparoscopic partial nephrectomy has lagged behind while laparoscopic radical nephrectomy is widely practiced and has become an established procedure. This lag is largely due to the technical difficulty in achieving renal hypothermia and securing renal parenchymal hemostasis.SummaryAdvanced laparoscopic suturing skills and the availability of laparoscopic vascular instruments have allowed laparoscopic partial nephrectomy to become a viable option for select patients, wherein laparoscopic partial nephrectomy attempts to duplicate traditional, established open surgical techniques.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Purpose of the reviewThe conviction that a renal cell carcinoma does not require the entire organ to be removed allows new therapeutic methods to be envisaged that involve only local tissue ablation, rather than the complete removal of the organ. The trend toward minimally invasive options in the management of renal tumours has prompted interest in energy-based ablation techniques as a possible alternative to radical or partial nephrectomy in selected patients. Cryoablation, radiofrequency interstitial tumour ablation, microwave thermotherapy and high-intensity focused ultrasound (HIFU) are among such techniques. HIFU has emerged as the least invasive of the possible tumour ablation methods. The present review addresses the current literature on experimental and clinical application of HIFU for extracorporeal organotripsy of renal tumours.Recent findingsClinical HIFU applications performed thus far in the treatment of renal tumours have only been experimental in nature. Specific case details were recently provided concerning a patient suffering from a multilocal renal cell carcinoma who underwent HIFU treatment with intent to cure, along with data from short-term (6 months) follow-up examinations.SummaryHIFU is a promising but presently experimental procedure. It will achieve routine clinical application when technical problems concerning visualization of the target organ and lesion, precise control of lesion size, complete ablation of the tumour mass and reduction in side effects (skin burns) have been resolved. The objectives of further developments are to optimize ultrasound coupling and to provide on-line ablation evidence. At this time, HIFU should be reserved for selected patients in well designed clinical studies.

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID

ISSN:0963-0643    

出版商:OVID    

年代:2003

数据来源: OVID