John G Pattaras1, Ross Milner. 1. Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA.
Abstract
INTRODUCTION: Laparoscopic radical nephrectomy has become an international standard of care for medium to large renal tumors. Endovascular aneurysm repair (EVAR) has been accepted as a reasonable alternative to open abdominal aortic aneurysm (AAA) repair. We report a case of minimally invasive management of two potentially lethal diseases in a single hospitalization. PATIENT AND METHODS: The patient is a 76-year-old male who was found to have an incidental finding of an AAA and an enhancing 9 cm left central renal mass. He was deemed to be an appropriate candidate for endovascular AAA repair and laparoscopic nephrectomy based on preoperative imaging. Secondary to mild, chronic renal insufficiency, a staged approach was planned: EVAR followed by nephrectomy. RESULTS: Successful minimally invasive treatments of the AAA and renal mass were accomplished in a staged fashion within 48 hours. The patient underwent successful EVAR for his inflammatory aneurysm and was admitted after the procedure for hydration and renal function monitoring. Two days later, a successful laparoscopic radical nephrectomy was performed. The patient was discharged postnephrectomy day 3 and hospital day 5. Pathology revealed a T2NxMx conventional renal cell carcinoma (RCC). He has been continuously followed for 4 years postoperatively with no evidence of cancer recurrence and a shrinking aneurysm sac without leak. CONCLUSIONS: We present a case of two potentially lethal disease processes previously handled in an open surgical fashion just a few short years ago. A combination of minimally invasive approaches in a staged fashion allowed a prompt patient recovery with no significant postoperative morbidity. To our knowledge, this represents the first case report of a staged minimally invasive treatment of synchronous vascular and renal pathology.
INTRODUCTION: Laparoscopic radical nephrectomy has become an international standard of care for medium to large renal tumors. Endovascular aneurysm repair (EVAR) has been accepted as a reasonable alternative to open abdominal aortic aneurysm (AAA) repair. We report a case of minimally invasive management of two potentially lethal diseases in a single hospitalization. PATIENT AND METHODS: The patient is a 76-year-old male who was found to have an incidental finding of an AAA and an enhancing 9 cm left central renal mass. He was deemed to be an appropriate candidate for endovascular AAA repair and laparoscopic nephrectomy based on preoperative imaging. Secondary to mild, chronic renal insufficiency, a staged approach was planned: EVAR followed by nephrectomy. RESULTS: Successful minimally invasive treatments of the AAA and renal mass were accomplished in a staged fashion within 48 hours. The patient underwent successful EVAR for his inflammatory aneurysm and was admitted after the procedure for hydration and renal function monitoring. Two days later, a successful laparoscopic radical nephrectomy was performed. The patient was discharged postnephrectomy day 3 and hospital day 5. Pathology revealed a T2NxMx conventional renal cell carcinoma (RCC). He has been continuously followed for 4 years postoperatively with no evidence of cancer recurrence and a shrinking aneurysm sac without leak. CONCLUSIONS: We present a case of two potentially lethal disease processes previously handled in an open surgical fashion just a few short years ago. A combination of minimally invasive approaches in a staged fashion allowed a prompt patient recovery with no significant postoperative morbidity. To our knowledge, this represents the first case report of a staged minimally invasive treatment of synchronous vascular and renal pathology.