Reduced blood loss by 90 percent, patient discharged in 24 hours. The operation was the only possible way to operate on the patient. Launched for the first time in 2005 in the USA, this technique is still not widespread in Italy
Rome, 24 January 2014 - Seven minutes of controlled closure of the renal artery to complete the removal of a tumor in the kidney and suture the sound part of it, working through four incisions of less than a centimeter in the lumbar part of the back. Result: a 90% less blood loss than the average, with the patient discharged after 24 hours, practically the times of a day hospital.
They are the numbers of the intervention with which the Prof. Maurizio Buscarini, head of the Operational Unit of Urology of the Campus Bio-Medico University Hospital, removed a PT1A tumor from the right kidney of a 53-year-old patient. To achieve it, the surgeon used a particular technique, which in specialized jargon is called 'retroperitoneoscopic partial nephrectomy'. Introduced in the United States in 2005, it is still little used in our country.
"This type of intervention explains Buscarini– it was necessary because the patient had been operated on several times, for gastric pathologies, with open operations on the abdomen and, due to the adhesions that had formed, it was no longer possible to operate via the abdomen. To remove this type of tumor with the laparoscopic technique, there is a need for adequate space within which to move the operating instruments: in our case, we could not count on the natural one, usually guaranteed by the peritoneal cavity. To create it, intervening from the back, i.e. from the back of the subject, we carried out an incision of just over a centimeter in the lumbar area, in correspondence with the kidney, by entering a dilator balloon which allowed us to 'detach' from the lumbar wall the whole area surrounding the kidney, in fact artificially creating our 'work room', i.e. the space within which to be able to move the laparoscopic instruments. These were passed through three further incisions, each half a centimeter in diameter".
Unlike the standard of this surgery, the surgeon has isolated only the renal artery, leaving the corresponding vein open, so as to minimize organ ischemia and possible irreversible damage to the healthy part of the kidney. Despite this, the blood loss was about 20 milliliters, against an average of 270 milliliters for the other cases operated on in Italy, because the removal of the tumor was completed in times well below the limit of 20 minutes reported in the literature.
According to 2013 data from the Italian Association of Medical Oncology (AIOM), Italy is one of the countries with the highest incidence of cases of kidney cancer: approximately 4,2% in men and 2,6% in women, an increase of 1,5% among men and stable among women. It is one of the most unpredictable tumors, since for a long time it can give no signals, and then break out quickly and devastatingly. Despite the growth in cases in recent years, however, life expectancy at five years is also increasing.
