Кафедра урології, нефрології та андрології імені професора А.Г. Подрєза
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Browsing Кафедра урології, нефрології та андрології імені професора А.Г. Подрєза by Author "Shchukin, Dmytro"
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Item A new surgical technique of the renal artery control during nephrectomy with tumor thrombus removal(2018-05) Lisovyi, Volodymyr; Shchukin, Dmytro; Khareba, Gennadiy; Garagatiy, Igor; Polyakov, Nikolay; Mozzakov, P.The nephrectomy safety during removal of kidney tumors with intravenous extension mostly depends on control of the renal arterу. But in certain situations control of the renal artery is a very complicated and dangerous stage of the operation due to presence of the venous collaterals and massive size of the tumor thrombus. Search of the renal artery often accompanied the displacement of the renal vein, inferior vena cava or kidney, which can lead to thrombus fragmentation and pulmonary embolism in the presence of fragile or soft tumor thrombus. We present a novel method of control of the renal artery after performing thrombectomy. Our experience has demonstrated the feasibility and safety of a new surgical technique, including anterior ligation of the renal artery after thrombectomy. This approach decreases the blood loss from the venous collaterals during kidney mobilization and reduces the risk of pulmonary embolism.Item Control of the renal artery after removal of tumor thrombus from the inferior vena cava: Analysis of the efficacy and safety of a new surgical approach(2016-03-13) Лісовий, Володимир Миколайович; Щукін, Дмитро Володимирович; Гарагатий, Ігор Анатолійович; Хареба, Геннадій Геннадійович; Поляков, Микола Миколайович; Shchukin, Dmytro; Lisovyi, Volodymyr; Garagatiy, Igor; Khareba, Gennadiy; Polyakov, M.The nephrectomy safety during removal of kidney tumors with intravenous extension mostly depends on control of the renal artery. We focused on efficacy and safety of a novel renal artery ligation technique after thrombectomy in comparison to the standard surgical techniques. Our study has demonstrated feasibility and safety of thrombectomy without prior ligation of the renal artery. The results of this technique were not related to the level of spread of intravenous tumor, and were significantly better than those with the use of the standard approaches to the renal artery in terms of technical feasibility and safety, due to the lower frequency of bleeding, and the absence of embolic complications.Item Formation of a Tunnel under the Major Hepatic Vein Mouths during Removal of IVC Tumor Thrombus(Hindawi Publishing Corporation, 2013) Shchukin, DmytroThis study describes a clinical observation of successful implementation of a new surgical maneuver: formation of a cross tunnel under the mouths of themajor hepatic veins during removal of a tumor thrombus of the inferior vena cava. This surgical technique helps avoid the usage of “piggyback” mobilization of the liver and the complications associated with it. However, for objective evaluation of this approach, a further clinical study is required.Item Identification of Bleeding Sources During Removal of Inferior Vena Cava Tumor Thrombi: Multidetector Computed Tomography Study(2013-12) Shchukin, Dmytro; Altukhov, Oleksiy; Lisova, Ganna; Ilyukhin, YuriyObjectives: The purpose of this study was to investigate the sources of bleeding from the lumen of the inferior vena cava (IVC) during removal of the tumor thrombus. We have studied the multidetector computed tomography (MDCT) anatomy of the posterior tributaries of the IVC, including variant lumbar veins and lumbar veins of the infrarenal IVC. Materials and Methods: The retrospective study included 302 patients who underwent the bolus contrastenhanced MDCT of the abdomen for various indications. We analyzed the anatomy of the variant lumbar veins and infrarenal IVC lumbar veins. Results: Variant lumbar veins were detected in 50% of patients (151 out of 302). The diameter of these vessels ranged from 1 mm to 5 mm and averaged 2.5 mm. The distance from the upper edge of the right renal vein mouth to the variant vein mouth varied from 0 mm to 51 mm and averaged 13.7 mm. In 71% of cases the variant veins entered the subhepatic IVC. In 26.3% of cases it drained at the level of the upper edge of the renal vein mouths (cavarenal segment) and only in 2% of cases—to the retrohepatic IVC. Lumbar veins entered the IVC immediately next to the lower edge of the right renal vein mouth in 35 (11.6%) cases. Their average diameter was 4.7 mm. On the left side of the "risk zone" the lumbar veins drained only in 2 (0.7%) patients at a distance of 7 mm and 8 mm from the mouth of the left renal vein. Conclusion: The variant lumbar veins rarely are the main source of bleeding during thrombectomy. From our point of view, the right upper lumbar veins of the infrarenal IVC draining into the inferior vena cava in close proximity to the mouths of the renal veins played the leading role in this matter.Item Nephron sparing surgery in patients with intravenous extension of renal cell carcinoma(2016-03-14) Стаховський, Е.О.; Щукін, Дмитро Володимирович; Лісовий, Володимир Миколайович; Вітрук, І.; Войленко, О.А.; Стаховський, О.Е.; Гарагатий, Ігор Анатолійович; Поляков, Микола Миколайович; Антонян, Ігор Михайлович; Хареба, Геннадій Геннадійович; Stakhovsky, E.; Shchukin, Dmytro; Lisovyi, Volodymyr; Vitruk, I.; Voylenko, O.; Stakhovskyi, O.; Garagatiy, Igor; Polyakov, M.; Antonyan, I.; Khareba, GennadiyWe have conducted a retrospective evaluation of the results of open nephron sparing surgery in patients with macroscopic intravenous extension of RCC found either during operation or at final pathomorphological study. The study included 32 patients with renal tumours and intravenous extension who underwent NSS from 2007 to 2015 in two urological centers. Their charts were reviewed to identify clinical, operative, and pathology details, as well as oncological outcomes of these patients. Nephron sparing surgery may be used to treat patients with kidney tumours and neoplastic venous thrombosis. Elective indications for this surgical approach are still to be developed.Item Sources of bleeding during IVC tumour thrombi removal: MDCT examination(2016-03-23) Лісовий, Володимир Миколайович; Щукін, Дмитро Володимирович; Алтухов, Олексій Олександрович; Савенков, Володимир Ілліч; Ілюхін, І.; Хареба, Геннадій Геннадійович; Єрмоленко, Тамара Іванівна; Lisovyi, Volodymyr; Shchukin, Dmytro; Altukhov, Oleksiy; Savenkov, V.; Ilyukhin, I.; Khareba, Gennadiy; Yermolenko, T.The purpose of this study was to investigate the sources of bleeding from the lumen of the inferior vena cava (IVC) during removal of the tumour thrombus. We have studied the MDCT anatomy of the posterior tributaries of the IVC, including variant lumbar veins and lumbar veins of the infrarenal IVC. The variant lumbar veins rarely are the main source of bleeding during thrombectomy. The right upper lumbar veins of the infrarenal IVC draining into the inferior vena cava in close proximity to the mouths of the renal veins played the leading role in this matter. Before the operation a surgeon must carefully plan the stage of vascular thrombus isolation and evaluate the anatomy of the upper lumbar veins with the use of the data of medical imaging.Item Surgical Approaches to Supradiaphragmatic Segment of IVC and Right Atrium through Abdominal Cavity during Intravenous Tumor Thrombus Removal(Surgical Approaches to Supradiaphragmatic Segment of IVC and Right Atrium through Abdominal Cavity during Intravenous Tumor Thrombus Removal / D. Shchukin, V. Lesovoy, I. Garagatiy, G. Khareba,R. Hsaine // Advances in Urology. – 2014. – Vol. 2014. – Article ID 924269. – Mode of access : http://dx.doi.org/10.1155/2014/924269., 2013-07) Shchukin, Dmytro; Lisovyi, Volodymyr; Garagatiy, Igor; Khareba, Gennadiy; Hsaine, RedouaneObjective.The purpose of this study was to investigate safety and feasibility of some surgical approaches to the supradiaphragmatic inferior vena cava (IVC) and the right atrium through the diaphragm from the abdominal cavity. Materials and Methods. The material of the anatomical study included 35 fresh cadavers. Several options of surgical access to the supradiaphragmatic IVC were successively performed. Feasibility and risk level of each of the approaches were evaluated with the use of a special scale. Results. The isolation of the supradiaphragmatic IVC and cavoatrial junction was most easily performed via T-shaped or circular diaphragmotomy (grade “easy” was registered in 74.3% and 80% of patients, resp., compared to 31.4% for transverse diaphragmotomy and 40% for isolation of the IVC in the pericardial cavity). The risk analysis has demonstrated the highest safety level for T-shaped diaphragmotomy (grade “safe” was registered in 60% of cases).The intervention via transverse diaphragmotomy, circular diaphragmotomy, and IVC isolation in the pericardial cavity was graded as “risky” in 80%, 62.9%, and 82.9% of cases, respectively. Conclusions. In our opinion, T-shaped diaphragmotomy is the most safe and easy-to-perform access for mobilization of the supradiaphragmatic IVC through the abdominal cavity.