Vital dye sham intrarenal lesions: Assessment of risk of intra-abdominal tumour spread during laparoscopic nephrectomy and morcellation

Summary

The advancement of a new surgical technique, such as laparoscopic nephrectomy, raises questions regarding its safety and efficacy. This minimally invasive procedure could have its major clinical utility in the treatment of malignant renal neoplasms. Adenocarcinomas of the kidney are well known for their propensity to seed should tumour spillage occur, as has been documented in the case of large transcutaneous biopsies [1–3]. It is vital to assess the feasibility of performing laparoscopic nephrectomy and morcellation without spilling cancer cells.

Thirteen pigs underwent general endotracheal anaesthesia and were placed in the modified left flank-up position for laparoscopic left nephrectomy. A 22 gauge spinal needle was used to inject 3–5 cm³ of vital dye into the antero-lateral aspect of the left kidney. Ten of the 13 kidneys were injected without immediate extravasation and underwent successful laparoscopic resection from the renal fossa. Seven of the 10 kidneys were subsequently removed from the abdominal cavity by open laparotomy and had clear resection margins without evidence of staining of either the parietal or visceral peritoneal lining. Three kidneys were placed into an intra-abdominal sack for subsequent tissue morcellation and extraction. While laparotomy in these three subjects revealed no staining in the area of initial resection, leakage of the bag by one method of morcellation resulted in spillage of stained tissue fragments.

Laparoscopic nephrectomy has been utilized for both benign and malignant diseases of the kidney, while questions regarding its efficacy in treating malignancy remain. It appears that the risk of tumour spillage may be obviated by careful wide excision during the nephrectomy, in addition to its successful removal.

Key Words:

• laparoscopy
• kidney
• nephrectomy
• malignancy
• metastasis
• porcine