Abstract

Recently, there has been a steady tendency to expand indications for organpreserving operations for kidney tumors.The success of the operation depends on many factors and, first of all, on the completeness of tumor removal and reliability of hemostasis without damage to the blood supply of the entire organ with a minimum time of thermal or cold ischemia. Particularly difficult for surgeon are tumors with intrarenal arrangement. This is due to difficulties of intraoperative determination of tumor localization, as well as technical aspects of removal of big newgrowth with the implementation of adequate hemostasis in the bed of the removed tumor. If resection of kidney poles with a tumor is a fairly simple operation, the enucleation of the latter in the depth of the parenchyma at the location in the middle segments of the kidney and in direct contact with large vessels, is of great technical complexity As a rule, central location of intrarenal tumor requires the "exposure" of kidney parenchyma by a separate incision, up to the sectional. The surgeon's task is to minimize such transparenchymal access, which creates difficulties with hemostasis in a limited space and time limit of thermal ischemia. Hemostatic insufficiency, in turn, can lead to postoperative bleeding, and formation of arteriovenous fistulas. Superselective embolization of branches of the renal artery supplying the intrarenal tumor ensures the subsequent optimal revision of the bed of the removed tumor, minimizes blood loss and allows to refuses blood flow arrest of entire organ.

Case report: article presents data of a young 33-year-old patient with a congenital anomaly in the blood supply of left kidney in the form of a multiple renal artery and kidney tumor T1AN0M0. Ultrasound, CT and MRI revealed an intraparenchymal tumor of the left kidney measuring 2,3x2,5x2,2 cm, with blood supply by 4 arteries extending from the aorta. As the first stage, superselective embolization of tumor's blood supplying artery with PVA 355-500 microns was performed. The second stage was the enucleation of a tumor of left kidney under the control of intraoperative ultrasound without thermal kidney ischemia. Intraoperative blood loss less than 150 ml. The patient was discharged on the 7th day

Conclusion: performing selective embolization of the renal artery feeding the tumor makes it possible to perform the operation without thermal ischemia of the kidney with minimal blood loss.

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Abstract:

Radiofrequency (RF) ablation is a minimally invasive method. Application of RF ablation allowed to expand indications for more radical treatment of kidney tumors in patients, whom traditional nephrectomy or kidney resection are impossible, due to extremely adverse somatic status

Efficiency and safety of RF ablation are significantly increased if preceded in combination with superselective occlusion of blood vessels, supplying the tumor. We possess the experience of application of superselective embolization in combination with RF ablation of two patients with kidney tumors. In both cases a good result of combined treatment has been observed.

This combination (superselective embolization + RF ablation) can be an alternative to open operation on kidney in number of patients, expanding the arsenal of modern minimally invasive kidney tumor's treatment methods. 

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