A new concept for minimally invasive treatment involves abdominal laparoscopic surgery performed while the patient breathes independently without losing consciousness. Here we report the first series of laparoscopic partial nephrectomy (LPN) performed under neuroaxial anesthesia (NA). From May 2021 to September 2022 we prospectively enrolled selected patients with an organ-confined single renal mass to undergo LPN under NA. Anesthesia was administered using an epidural catheter placed at the level of T7, with additional anesthesia at the level of T10. The rationale was to avoid use of a tracheal tube and the side effects of general anesthesia. Ten patients were enrolled in the study. Targeted sedation was achieved in all cases. In one case, a switch to general anesthesia was needed because of patient anxiety. Food intake started at 12 h after surgery in 9/10 cases; mobilization started from 3 h after surgery. The length of hospital stay was 3 d in 4/10 cases and 4 d in 3/10 cases. This first experience worldwide of LPN performed under NA demonstrates the feasibility and safety of the procedure.
European urology open science. 2023 Sep 25*** epublish ***
Alberto Piana, Fernando Chiaravalloti, Francesco Chiaradia, Antonio Greco, Jacopo Lauria, Giulio Zappalà, Manlio Cappa, Vincenzo Pagliarulo, Carmine Pullano, Enrico Checcucci, Daniele Amparore, Michele Di Dio, Marcello Scarcia, Francesco Porpiglia, Stefano Alba
Department of Urology, Romolo Hospital, Rocca di Neto, Italy., Department of Anesthesiology, Romolo Hospital, Rocca di Neto, Italy., Department of Urology, Vito Fazzi Hospital, Lecce, Italy., Department of Anesthesiology, Villa Pia, Roma, Italy., Department of Surgery, Candiolo Cancer Institute FPO-IRCCS, Candiolo, Turin, Italy., Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy., Division of Urology, Department of Surgery, Annunziata Hospital, Cosenza, Italy., Urology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy.