Category: Laparoscopic/ Robotic: Renal

VS16-14 - Use of intraoperative laparoscopic ultrasound. A helpful tool for guiding nephron sparing surgery.

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective :

In the recent years, development in techniques and surgeon’s skills have led to an increase of nephron sparing surgery for renal masses with good oncological results.

The use of intraoperative US in selected patients with centrally located tumors in close contact to the renal sinus, could increase the eligibility of patients for laparoscopic partial nephrectomy.

Despite the inherent challenges of performing LPN, various evolutions in our technique have allowed us to approach more difficult surgical situations such as intrarenal tumours.

Several publications have presented the results of series of patients treated with these techniques in the past years.

The aim of this video is to present a clinical case of an intraoperative ultrasound guided laparoscopic partial nephrectomy proving its feasibility in selective cases of intrarenal tumours.

Methods :

We present the case of a 53-year-old man with medical history of controlled HIV infection and dyslipidaemia.

During a routine abdominal ultrasound, he was incidentally diagnosed a 16 mm intraparenchymatous left renal mass.

The study was completed with MRI and CT scan that showed a heterogeneous solid mass in the interpolar region of left kidney.

According to nephrometry the tumour presented a Renal score of 10P and Padua score of 11P.

Due to the inmunosupressive state, age and personal choice, an intraoperative echography guided LPN was planned.

In the video, we present the different steps of surgery and show the applicability of the technique.



Results :

Operative time was 3hours and 20 minutes with an estimated blood loss of 500cc. Warm ischemia time was 25 min and 27 seconds.

Postoperative course was uneventful and patient was discharged in the 4thpostoperative day.

The histopathological exam revealed a clear cell carcinoma of 1,6 cm diameter, pT1a stage ISUP grade 1, with free margins.

After four months follow up patient is recurrence free.

Conclusions :

We conclude that Intraoperative ultrasound may play an additional role in laparoscopic management of small intraparenchymatous renal masses, expanding the indications for laparoscopic partial nephrectomy.  Although indications for its use are not standardized.

Despite complexity, results have shown the safety and feasibility of this procedure.


Maria Rodriguez-Monsalve Herrero

University Hospital Puerta de Hierro, Majadahonda.
Majadahonda, Madrid, Spain

Ignacio T. Castillón Vela

Staff urologist
H.U. Puerta de Hierro. Majadahonda
Villaviciosa de Odón, Madrid, Spain

Consultant Urologist. Department of Urology.
Hospital Universitario Puerta de Hierro Majadahonda
H.U. Madrid Torrelodones.
Escuela Europea de Laparoscopia Urológica. Madrid

1984-1990 Doctor of Medicine. Universidad Autónoma de Madrid
1992-1997 Urology Residency. Department of Urology. Fundación Jiménez Díaz. Madrid.
1998. Certificate. Educational Comission for Foreign Medical Graduates (ECFMG).
2/1999- 1/2001 Clinical Fellow in Kidney and Pancreas Tansplantation
National Institute of Transplantation - St Vincent Medical Center. Departament of Urology. University of Southern California (USC). Los Ángeles, California. EEUU.
2001 PhD in Medicine and Surgery. Universidad Autónoma de Madrid.
2005-2006 Master in Medical Direction and Clinical Management Universidad Nacional de Educación a Distancia (UNED)
2008 University Expert Certificate in “E learning 2.0: Internet Education and On line training". Universidad Nacional de Educación a Distancia (UNED)
2009 Accreditation as Da Vinci Robot Console Surgeon.

Editor of 4 Books
Author in 5 chapters in urological Books
Editor/Author of 9 Audiovisual Projects
27 Articles in indexed Journals
85 Panel Presentations in Urological Meetings
114 Podium/Poster/Video presentations at urological meetings.

Reviewer for the following Journals:
- Archivos Españoles de Urología
- Urology
- Journal of Endourology
Reviewer for the selection commitee:
- Spanish AEU Annual Meeting
- European Association of Urology (EAU) Annual Meeting

Esau Fernández Pascual

University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain

Gema Del Pozo Jiménez

Staff Urologist
University Hospital Puerta de Hierro, Majadahonda.
Madrid, Madrid, Spain

- 2003-2009: Doctor of Medicine and Surgery (MD). University of Alcalá, Madrid, with a final grade of Honours.
- 2010-2015: Urology Residency. General University Hospital Gregorio Marañón, Madrid.
- 2013-2017: Degree in Design and Statistics in Health Sciences. Autonoma University of Barcelona.
- November, 2014: European Board of Urology (EBU) Online Written Examination. Madrid.
- June, 2015: European Board of Urology (EBU) Oral Examination. Brussels.
- 2013-2017: PhD. Complutense University of Madrid with mention of "Cum laude" with the title: Predictive model of mortality in patients with transitional bladder cancer treated with radical cystectomy.
- October 2017: Enrollment in the Master in Health Research Methodology. Autonoma University of Barcelona.
- January-May 2018: University Title of Expert in Urooncology of the Autonoma University of Madrid,
- Currently working as FEA of Urology since June 2015 in Puerta de Hierro University Hospital (Majadahonda), as well as a private activity in H.U. La Zarzuela and H. University H.M. Torrelodones.
• Practical teaching in the subject of Urology of the Autonoma University of Madrid in H.U.Puerta de Hierro (2015-2018).
• Online teaching as a professor in the course of laparoscopic and robotic radical cystectomy (1st Edition) of the European School of Urological Laparoscopy (2018).
3.-PUBLICATIONS IN JOURNALS: Five publications as author, four publications as co-author (three in Spanish Archives of Urology and one chapter of the Urology Resident's Book (Internet)) and four abstracts of European and world congresses, three as author and one as co-author (European Urology Supplements and Journal of Endourology).
4- COMMUNICATIONS PRESENTED AT NATIONAL CONGRESS: As author 32 papers: Eighteen papers and as co-author 36 co-author papers.
5- SUBMITTED VIDEOS IN CONGRESS: 14 videos as author and 6 videos as co-author.
6-COMMUNICATIONS/VIDEOS PRESENTED AT INTERNATIONAL CONGRESS: As author (9 presentations) and as co-author (4 presentations).

Joaquin Carballido

Chairman. Urology Department
H.U. Puerta de Hierro Majadahonda
Majadahonda, Madrid, Spain