Emerson is a destination for the most complex kidney surgery


7/24/2018

Michael Correale won’t ever forget that day last summer when painful symptoms convinced him to rush to the nearby emergency department. After a nerve-wracking CT scan was performed, the bad news kept coming: he had kidney cancer, there was a large mass on his left kidney, and the kidney needed to be removed. “I thought I was a goner,” says Mr. Correale, a Peabody resident.
 
When Mr. Correale (pictured at right) subsequently learned that he had bilateral kidney cancer (cancer in both kidneys), he began to carefully consider which surgeon should perform the complex procedures he was facing: removal of the tumor in his right kidney — importantly, in a way that would leave him with one healthy, functioning kidney — and then removal of his left kidney.
 
“My urologist referred me to Dr. Libertino, because he has performed more complex kidney surgery than anyone in New England,” says Mr. Correale, referring to John Libertino, MD, medical director for Emerson Urology Associates. “When I met him, I could see how confident he was. He told me he would clean out the cancer, and my right kidney would be fine.”
 
Dr. Libertino has reason to feel confident in his ability to perform complex urologic surgery — notably when there is cancer in both kidneys. He developed the surgical technique that avoids clamping the major artery adjacent to the kidney when performing a partial nephrectomy, surgery that removes just the tumor and nearby tissue. “Clamping the artery can damage the kidney and may later result in chronic kidney disease,” he explains.
 
There was another reason why Dr. Libertino had the specific expertise that Mr. Correale required. The large tumor and his vena cava — the major vein that runs next to the kidney and returns all the blood to the heart — were wrapped around critical structures, including the common bile duct, portal vein and hepatic artery. “This is very unusual,” says Dr. Libertino, who also has training in vascular surgery and performed pioneering work in advanced kidney cancer, which can grow within the vena cava and into the heart.
 
Dr. Libertino consulted with Lisa Intriere, MD, an Emerson radiologist, who studied Mr. Correale’s images and had good news: the tissue entangling his vena cava was a hemangioma, a benign liver growth.
 
“That meant we didn’t have to touch it, and we saved him from having a separate, difficult operation — one that would put him at risk for potential injury,” Dr. Libertino notes.
 
Expertise at Emerson supports highly complex cases
 
Mr. Correale’s first surgery, the partial nephrectomy, was performed in September with Jason Gee, MD, joining Dr. Libertino in the operating room (OR). Once he had recovered, the team turned its attention to removal of his left kidney. Adhip Mukerjee, MD, an interventional radiologist at Emerson, first performed an angio-infarction — a procedure that blocked blood flow and shrunk Mr. Correale’s large tumor. This would result in less blood loss when the tumor was removed.
 
In November, the two urologists performed a total nephrectomy to remove Mr. Correale’s left kidney. “It was one of the largest tumors I’ve seen,” says Dr. Gee, noting that it was pushing against his pancreas and spleen.
 
The five-hour surgery was successful, and the subsequent pathology report brought good news: all of the 45 lymph nodes removed during the surgery and the tumor margins were negative, meaning his cancer was confined to the kidney. “Dr. Libertino said to me: ‘that’s the best news you can get,’” says Mr. Correale, who works as a foreman for National Grid.
 
He spent a few days recovering at Emerson and was pleased with the care he received. “I had some great nurses,” he says. It didn’t take him long to see that he would do fine with one kidney.
 
Mr. Correale benefited from a high level of urologic expertise, as well as the deep experience of the Emerson medical and nursing staff. “We have a great team here, including anesthesiologists and OR staff who know how to get patients through long, complex operations and outstanding staff in the intensive care unit,” says Dr. Libertino.
 
An increasing number of patients are arriving from well beyond the Emerson service area — outside the state and even the U.S. — to have complex urologic surgery at Emerson. Dr. Gee’s focus on the newest approaches to treating bladder surgery is one reason. He performs surgery to create a new bladder in cases where the bladder must be removed.
 
“Neobladder surgical reconstruction uses a segment of the patient’s intestine to restore the anatomy,” he explains. “People are pleased, because it means they avoid having to wear a urostomy bag to collect urine.”
 
Practice covers full range of urology conditions — for men and women
 
The growth of Emerson Urology Associates has made Emerson a destination for those who require complex urologic surgery. However, the hospital has always had talented, experienced urologists who provide comprehensive care and perform a range of surgical and other procedures. Paul LaFontaine, MD, and Stephen Schloss, MD, are well-known urologists who have many loyal patients in the community. Jacqueline Brecht, MD,  (pictured at right) who recently joined Emerson Urology Associates, brings her interest in the diagnosis and treatment of bladder conditions.
 
There has been notable progress in the field of prostate cancer, both in diagnosis and treatment, notes Dr. Schloss. “Improved and more specific imaging has enabled us to diagnose prostate cancer at an earlier point, as well as differentiate aggressive from non-aggressive cancers. Also, we are able to manage many prostate cancers today with surveillance as opposed to radical surgery.”
 
New treatment options feature advanced technology, notes Dr. LaFontaine. “For treatment of benign prostatic hyperplasia, we now use the GreenLight laser, which is associated with less bleeding, so is recommended for men on blood-thinners,” he says. “We are seeing an impressive success rate in treating kidney stone disease with the holmium laser.”
 
Mr. Correale knows he went to the right place for treatment. His prognosis is good, and he’s getting stronger all the time. “I can’t say enough about Dr. Libertino and Dr. Gee,” he says.
 
Urodynamics testing facility provides clarity on treatment
 
Located in a small room at Emerson Urology Associates are the components needed to help define treatment for many patients with annoying symptoms. The urodynamics testing facility consists of a bed, a small toilet, a unit that measures bladder pressure and a laptop.
 
Determining bladder pressure is useful when men or women are living with symptoms, such as frequent urination, having difficulty getting the urine stream started, waking at night to urinate, a sudden strong urge to urinate or a urine stream that stops and starts.
 
“Men and women should not assume they must live with these problems,” says Dr. Brecht. “Today we have many treatments that can be quite effective. On the other hand, there are several things people can do that don’t involve medication or surgery, such as avoiding caffeinated, acidic and alcoholic beverages, which can irritate the bladder. I always begin with an evaluation and review of the patient’s health history.”
 
In many cases, the next step is to perform urodynamics testing, which is considered to be the gold standard for bladder testing. An experienced urodynamics nurse conducts the test, which includes the placement of two tiny sensors that check bladder pressure. Every effort is made to assure the comfort of patients.