Intraoperative ultrasound during renal parenchymal sparing surgery for hereditary renal cancers: A 10-year experience

Purpose: We review our 10-year experience with intraoperative ultrasound du ring renal parenchymal sparing surgery in patients with hereditary renal ca ncers. Materials and Methods: Between 1991 and 2000, 68 nephron sparing procedures were performed on 26 women and 27 men, all but I of whom had a hereditary predisposition to renal cancer, for example von Hippel-Lindau, hereditary p apillary renal cancer. Intraoperative ultrasound was performed after the su rgeon removed all visible or palpable lesions. High frequency transducers ( 7 MHz.) and color Doppler were used in all cases. Lesions were characterize d as simple cysts, complex cysts or solid masses, and were recorded on a ma p. Results: A total of 935 lesions (mean 12.8 lesions per kidney) were removed in 68 nephron sparing operations performed on 53 patients. Of these lesion s 870 were removed without while 65 required intraoperative ultrasound. In 17 of 68 (25%) procedures intraoperative ultrasound identified renal cancer s that were not detectable by the surgeon. Mean tumor size of ultrasound de tected lesions was 1.0 cm. (range 2 mm, to 4 cm.). Of the 32 cystic lesions identified by intraoperative ultrasound 5 contained renal carcinoma, and 2 9 of the 33 solid renal masses were renal cell carcinomas. During reoperati ons ultrasound enabled the surface of the kidney to be evaluated even when it was inaccessible due to scar tissue or adherent perinephric fat. Conclusions: Intraoperative ultrasound can be performed after all visible l esions have been removed and identifies additional tumors in 25% of patient s with hereditary renal cancer, thus ensuring that as many tumors as possib le have been removed during renal parenchymal sparing surgery.