2018 Program “Take Aways” from Dr. John Barry

USTRS ANNUAL MEETING HIGHLIGHTS – MAY 21, 2018, SAN FRANCISCO

BY JOHN M. BARRY, MD, IMM. PAST PRESIDENT

Breakfast Hour.

  • For minimally invasion renal surgeries, use the flank position and a retroperitoneal approach for posterior and lateral tumors, for patients who’ve had prior abdominal surgery, and obese patients.
  • Airseal will allow constant CO2 pressure (12 mm = good) during instrument changes and suction.
  • A 10 mm Satinsky will allow en masse hilar vascular control during partial nephrectomy.
  • Neuromuscular stimulation (muscle pump activator) as a substitute for sequential compression devices results in more comfort, decreased post-op leg edema, better wound healing, better sleep, and is preferred by patients.

 

IVC Tumor Thrombus Hour.

  • MRI is the gold standard to show bland and tumor thrombus in the IVC.
  • Cut open the gonadal vein stump to check for complete occlusion of IVC and its branches.
  • Avoid pre-op embolization before nephrectomy; the surgery is less complicated..
  • When pinched, Goretex vascular suture is less likely to break than monofilament vascular suture.
  • Mobilization of the right lobe of the liver and dissection of the diaphragm off the IVC will allow one to expose the right atrium without a sternotomy.
  • Goretex graft can be used to replace the IVC.

 

Male Fertility and Hormones Hour.

  • Chronic renal failure is associated with decreased testosterone levels and poor semen quality.
  • Transplantation results in improvement of testosterone levels and semen quality.
  • Sirolimus and everolimus can result in male hypogonadism.
  • Offspring of immunosuppressed men are not at increased risk for congenital anomalies.

 

Novick Awards.

  • When compared with laparoscopic-assisted nephrectomy (LAN), robotic-assisted laparoscopic nephrectomy (RALN) is less like likely to be converted to open nephrectomy (ON). This may be due to case selection because of the ease of conversion of LAN to ON.
  • Bilateral nephrectomy, open or laparoscopic, and kidney transplantation can be done under the same anesthetic. It results in fewer hospital days than when the procedure are staged.
  • Delayed graft function is rare (~4%) after living donor kidney transplantation.
  • Including an IVC tumor thrombus in the renal vein staple line, removing the tumor-bearing kidney, then dealing with the IVC and the trapped tumor thrombus is an option to the standard approach of en bloc removal of the kidney and IVC tumor thrombus.
  • Laparoscopic donor nephrectomy is not compromised by a circumaortic left renal vein.
  • The Mayo Adhesive Probability (MAP) Score can predict difficulty of dissection due “sticky fat,” and lower-than-expected one-month recipient glomerular filtration rate (GFR). (Novick Award winner).