LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR RENAL TUMOR: DUPLICATING OPEN SURGICAL TECHNIQUES

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Feb 2002LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR RENAL TUMOR: DUPLICATING OPEN SURGICAL TECHNIQUES INDERBIR S. GILL, MIHIR M. DESAI, JIHAD H. KAOUK, ANOOP M. MERANEY, DAVID P. MURPHY, GYUNG TAK SUNG, and ANDREW C. NOVICK INDERBIR S. GILLINDERBIR S. GILL , MIHIR M. DESAIMIHIR M. DESAI , JIHAD H. KAOUKJIHAD H. KAOUK , ANOOP M. MERANEYANOOP M. MERANEY , DAVID P. MURPHYDAVID P. MURPHY , GYUNG TAK SUNGGYUNG TAK SUNG , and ANDREW C. NOVICKANDREW C. NOVICK View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)69066-9AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We describe our technique of and single institutional experience with purely laparoscopic partial nephrectomy for renal tumor, wherein the focus is to duplicate established open techniques of oncologic nephron sparing surgery. Materials and Methods: Since August 1999 laparoscopic partial nephrectomy for renal tumor has been performed in 50 patients. Of the patients 24 (48%) had either a compromised contralateral kidney (20) or a solitary kidney (4). Mean tumor size was 3.0 cm. (range 1.4 to 7). In 9 patients (18%) the inner margin of the tumor was in close proximity to the pelvicaliceal system. Our current laparoscopic technique involves preoperative ureteral catheterization, laparoscopic renal ultrasonography, transient atraumatic clamping of the renal artery and vein, tumor excision with an approximate 0.5 cm. margin using cold endoshears and/or J-hook electrocautery, pelvicaliceal suture repair (if necessary) and suture repair of the renal parenchymal defect over surgicel bolsters. In 1 case renal surface hypothermia was achieved laparoscopically with ice slush. All suturing and knot tying were performed with free hand intracorporeal laparoscopic techniques exclusively. Results: All procedures were successfully completed without open conversion. Mean surgical time was 3.0 hours (range, 0.75 to 5.8) and mean blood loss was 270.4 cc (range 40 to 1,500). Mean warm ischemia time was 23 minutes (range, 9.8 to 40). Caliceal entry in 18 cases (36%) was suture repaired in a watertight manner. Following caliceal repair, none of these 18 patients had a postoperative urine leak. Hospital stay averaged 2.2 days (range 1 to 9). Major complications occurred in 3 patients (6%) including intraoperative hemorrhage in 1, delayed hemorrhage necessitating nephrectomy in 1 and urine leak in 1. Renal cell carcinoma was confirmed on pathological examination in 34 patients (68%), and all had negative inked surgical margins for cancer. During a mean followup of 7.2 months (range 1 to 17) no patient has had local or port site recurrence or metastatic disease. Conclusions: Laparoscopic partial nephrectomy is a viable alternative for select patients with a renal tumor. 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Google Scholar From the Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, The Cleveland Clinic Foundation, Cleveland, Ohio© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited ByLaguna M (2018) Re: Oncologic Outcomes of Patients with Positive Surgical Margin after Partial Nephrectomy: A 25-Year Single Institution ExperienceJournal of Urology, VOL. 201, NO. 1, (27-28), Online publication date: 1-Jan-2019.Shah P, Moreira D, Patel V, Gaunay G, George A, Alom M, Kozel Z, Yaskiv O, Hall S, Schwartz M, Vira M, Richstone L and Kavoussi L (2018) Partial Nephrectomy is Associated with Higher Risk of Relapse Compared with Radical Nephrectomy for Clinical Stage T1 Renal Cell Carcinoma Pathologically Up Staged to T3aJournal of Urology, VOL. 198, NO. 2, (289-296), Online publication date: 1-Aug-2017.Laguna M (2018) Re: Findings and Impact of Early Imaging after Partial NephrectomyJournal of Urology, VOL. 198, NO. 2, (253-254), Online 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Volume 167Issue 2 Part 1February 2002Page: 469-476 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordslaparoscopynephrectomyrenal cell carcinomaMetricsAuthor Information INDERBIR S. GILL Requests for reprints: Section of Laparoscopic & Minimally Invasive Surgery, Urological Institute, A-100, The Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, Ohio 44195. More articles by this author MIHIR M. DESAI More articles by this author JIHAD H. KAOUK More articles by this author ANOOP M. MERANEY More articles by this author DAVID P. MURPHY More articles by this author GYUNG TAK SUNG More articles by this author ANDREW C. NOVICK More articles by this author Expand All Advertisement PDF DownloadLoading ...