Port Site Recurrence Prevention

Several steps should be taken in order to prevent port site seeding and tumor spillage (Table 2):

■ The historical developments of basic cancer surgery principles must be followed; experience with laparoscopic oncology is paramount—as port site recurrence has been shown to fall with experience (86).

■ Ascitic fluid suspicious for malignancy should be sent for cytology with exhaustive efforts to keep this fluid away from fresh surgical wounds.

■ Direct handling of the tissue must be minimized and attempts made to prevent violation of the tumor.

■ Wide en bloc dissection should be performed to avoid tumor spillage and to obtain appropriate surgical margins.

■ All potentially cancerous tissue should be entrapped in an impermeable sack (examined for perforations prior to abdominal placement) and the field draped prior to laparoscopically monitored morcellation or extraction (24,40,71).

■ During tissue delivery, all possible contaminated instrumentation should be removed from the newly towel-draped operative field, the surgeon's gloves exchanged for new, and formal peritoneal closure performed (90).

■ Potential intraperitoneal immune or adhesion modifiers such as endotoxin (87), heparin (91,92) or helium pneumoperitoneum (93), povidine iodine or taurolidine (92,94-96) may prove beneficial in the prevention of port site recurrence in future.

Although local recurrence of renal cell carcinoma has been reported following percutaneous radio frequency ablation, no radio frequency-, cryo-, or microwave-probe tract recurrences have been reported in the urologic literature to date.

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