VITAL DYE SHAM INTRARENAL LESIONS - ASSESSMENT OF RISK OF INTRAABDOMINAL TUMOR SPREAD DURING LAPAROSCOPIC NEPHRECTOMY AND MORCELLATION

The advancement of a new surgical technique, such as laparoscopic neph rectomy, raises questions regarding its safety and efficacy. This mini mally 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 occ ur, as has been documented in the case of large transcutaneous biopsie s [1-3], It is vital to assess the feasibility of performing laparosco pic nephrectomy and morcellation without spilling cancer cells. Thirte en 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 anterolateral aspect of the left kidney. Ten of the 13 kidneys we re injected without immediate extravasation and underwent successful l aparoscopic resection from the renal fossa. Seven of the 10 kidneys we re subsequently removed from the abdominal cavity by open laparotomy a nd 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 ex traction. While laparotomy in these three subjects revealed no stainin g in the area of initial resection, leakage of the bag by one method o f morcellation resulted in spillage of stained tissue fragments. Lapar oscopic nephrectomy has been utilized for both benign and malignant di seases of the kidney, while questions regarding its efficacy in treati ng malignancy remain. It appears that the risk of tumour spillage may be obviated by careful wide excision during the nephrectomy, in additi on to its successful removal.