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Abstract
Purpose:
The popularity of a partial nephrectomy has grown as a consequence of the increased detection of small incidental renal masses. Herein, our experience of laparoscopic partial nephrectomies is reported.
Materials and Methods:
Between December 2003 and April 2006, 27 cases underwent a laparoscopic partial nephrectomy for renal tumors up to 4cm in diameter. The tumors, and an approximate 0.5cm margin around the tumors, were resected with cold scissors. Hemostasis was achieved with freehand suturing of the pelvocalyceal system and renal parenchyme, over the surgical bolster, using fibrin glue.
Results:
Transperitoneal and retroperitoneal approaches were chosen in 14 and 13 cases, respectively. Hilar clamping of small exophytic tumors was performed in all but 3 cases, with minimal parenchymal invasion. The mean renal tumor size was 2.5cm (ranging from 1 to 4cm). The mean operative and warm ischemia times, and blood loss were 193 minutes (ranging from 115 to 300) and 27.8 minutes (ranging from 15 to 43), and 493ml (ranging from 32 to 1,248), respectively. The mean hospitalization stay was 5.2 days (ranging from 3 to 8 days). Conversion to a laparoscopic radical nephrectomy was required in one case due to a positive frozen biopsy of the resection bed. There were no perioperative complications or open conversions. Histological examinations yielded a renal cell carcinoma in 20 cases, an angiomyolipoma or oncocytoma in 2 cases each, a lipoma in 1 and a leiomyosarcom in 2 cases, two of which had positive margins. One patient underwent selective angioembolization for an asymptomatic renal artery pseudoaneurysm three months postoperatively. All patients were alive, without any local recurrence or metastatic disease, at a mean follow up of 11.4 months (ranging from 3 to 24 months).
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Fig. 1.
A straight line is drawn from the renal hilum to the lateral border of the kidney. Any tumor falling anterior to this line is approached transperitoneally (A) whereas, any tumor posterior to this line is resected through a retroperitoneal approach (B). If the line transgresses the tumor, an approach transperitoneal is used.
Fig. 2.
(A) Transperitoneal approach. (B) Retroperitoneal approach. ᄋ: 10mm camera port, ·æ additional 10mm port.
Fig. 3.
(A) The tumor is resected with cold scissors, with an approximate 0.5cm margin maintained around the tumor. (B) A renal parenchymal defect is approximated with freehand suturing, over the surgical bolster, using fibrin glue.
Fig. 4.
(A) DMSA scan shows a focal photon defect due to a partial nephrectomy in the lower pole of the right renal cortex and medulla. (B) The uptake rates are 19.3% and 13.4% (0.014619%/pixel and 0.009962%/pixel) for the left and right kidneys, respectively. DMSA scan: 99mTc-dimercaptosuccinic acid scintigraphy.
Table 1.
The demographic data on 27 patients
Table 2.
Operative data
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