Instrumental palpation in endoscopic renal surgery: case reports and analysis

Abstract

Palpation is one of the classic examination methods in open surgeries. In minimally invasive surgery, intra-operational manual palpation is impossible to use for assessing tactile characteristics of tissues. In Russia, the only available instrument for intra-operational assessment and objective registration of tissue visco-elastic properties is the Medical Tactile Endosurgical Complex (MTEC). The aim of this work was to study the performance of MTEC in renal surgery. The study was performed during nine elective laparoscopic surgeries for clear cell renal carcinoma and simple renal cysts. We have found several differences in the use of MTEC in renal surgery, as compared to its use in gastrointestinal or lung surgeries. The key factor determining these differences was the inverse relations between tissue visco-elastic properties: the studied tumors were softer than the surrounding tissue. Detection of intraparenchymal tumors by tactile methods was impossible. For surface tumors, in one case out of nine it was possible to strictly locate the border of the tumor by tactile examination. We were able to quantitatively assess and determine the difference in hardness of tumors and intact tissue using MTEC. This allows studying the prognostic value of objectively registered tactile characteristics of renal tumors.