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| Ultrasound-guided paravertebral nerve block anesthesia for percutaneous endoscopic laser unroofing treatment of symptomatic simple renal cysts—An innovative ambulatory surgery mode |
Jia Hua,*,1( ),Yuan Zhanga,1,Yong Liub,Xiao Yua,Shaogang Wanga,*
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aDepartment of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
bDepartment of Anesthesiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China |
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Abstract Objective: This study was designed to evaluate the feasibility, efficacy, and safety of percutaneous ureteroscopy laser unroofing as an ambulatory surgery for symptomatic simple renal cysts under multilevel paravertebral nerve block anesthesia. Methods: From December 2015 to September 2017, 33 simple renal cyst patients who had surgical indications were enrolled. Under ultrasound guidance, the T10/T11, T11/T12, and T12/L1 paravertebral spaces were identified, and 7-10 mL 0.5% ropivacaine was injected at each segment. Then a puncture needle was placed inside the cyst cavity under ultrasonic monitoring. A guidewire was introduced followed by sequential dilation up to 28/30 Fr. The extra parenchymal portion of the cyst wall was dissociated and incised using a thulium laser, and a pathological examination was performed. Results: Sensory loss to pinprick from T8 to L1 and sensory loss to ice from T6 to L2 were observed in all patients. None of the patients complained of pain during surgery. No serious complications occurred perioperatively. After the surgery, all patients recovered their lower limb muscle strength quickly, got out of bed, resumed oral feeding, and left the hospital within 24 h of admission. The pathologic diagnosis of all cyst walls was a simple renal cyst. The mean follow-up was 35.8 months. At the end of follow-up, the cyst units were reduced in size by more than 50% compared to the preoperative size, and no patient experienced a recurrence. Conclusion: Multi- level paravertebral nerve block for percutaneous ureteroscopy laser unroofing as an ambulatory surgery mode is feasible, safe, and effective for the treatment of simple renal cysts in selected patients.
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Received: 16 May 2021
Available online: 20 January 2024
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Corresponding Authors:
*E-mail address: sgwangtjm@163.com (S. Wang).
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| About author:: 1 Jia Hu and Yuan Zhang contributed equally to this study. |
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| Variable | Data | | Patient, n | 33 | | Sex, n (%) | | Male | 19 (57.6) | | Female | 14 (42.4) | | Age, mean (range), year | 47.7 (37.0-76.0) | | Body mass index, mean (range), kg/m2 | 25.2 (22.4-38.2) | | Cyst side, n (%) | | Right | 18 (54.5) | | Left | 15 (45.5) | | Number of cysts, n (%) | | 1 | 28 (84.8) | | >1 | 5 (15.2) | | Cyst location, n (%) | | Upper | 9 (27.3) | | Middle | 17 (51.5) | | Lower | 7 (21.2) | | Clinical symptom, n (%) | | Flank or abdominal pain | 24 (72.7) | | Renal lump | 9 (27.3) | | Diameter of cyst, maximum (range), cm | 6.1 (5.3-8.7) | | Bosniak classification, n (%) | | I | 30 (90.9) | | II | 3 (9.1) | | Previous operation, n (%) | 0 (0) |
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Patient characteristics.
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The procedures for ultrasound-guided paravertebral block anesthesia. (A) The levels of nerve block planned for patients were T10/T11, T11/T12, and T12/L1, respectively, and the linear array ultrasound 5- to 10-MHz probe was rotated to the sagittal plane; (B) The transverse processes of T11 and T12 were in the same visual field, and the superior costotransverse ligament and pleura were identified (the blue area); (C) A 100-mm, 21-gauge Tuohy needle (arrow) was introduced into superior costotransverse ligament under direct visualization of the needle tip; (D) Sensory loss to pinprick from T8 to L2 and sensory loss to ice from T6 to L2 were evaluated in all patients 20 min after administration of block.
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The procedures for percutaneous ureteroscopy laser unroofing treatment of simple renal cysts. (A) A needle (arrow) was introduced inside the cyst cavity under ultrasound guidance; (B) Using fascial dilators, a working channel was dilated in a sequential fashion up to 28/30 Fr, and a 28/30 Fr Amplazt sheath was placed inside the cyst cavity; (C) The interior cyst was observed with an 8/9.8 Fr rigid ureteroscope; (D) The sheath and the ureteroscope both returned to the exterior cyst, and then reached a proper plane between the extra-parenchymal portion of the cyst and perirenal adipose; (E) The exterior cyst wall was dissociated and grasped and pulled towards the Amplazt sheath interior, and then it was incised using a thulium laser; (F) The incised cyst wall tissue was sent for histopathologic analysis.
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| Variable | Upper boundary | Low boundary | | T6 | T7 | T8 | L1 | L2 | L3 | | Sensory loss to pinprick, n | 8 | 18 | 7 | 9 | 21 | 3 | | Sensory loss to ice, n | 7 | 20 | 6 | 6 | 19 | 8 |
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Assessment of the sensory block level in patients 20 min after paravertebral block (n=33).
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Imaging data for two patients in this study. (A) Preoperative CT for Patient A with peripheral cysts; (B) Postoperative CT for Patient A after follow-up of 1 year; (C) Preoperative CT for Patient B with peripheral cysts; (D) Postoperative CT for Patient B after follow-up of 1 year.
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