Introduction and Objectives
Nowadays, nephron sparing surgery has become a standardized procedure in sporadic, clinically T1 tumour. Laparoscopic nephron sparing surgery (LNSS) is a technically challenging procedure. In many centers LNSS is a viable alternative to open surgery, combines the benefits of the minimal invasive approach and efficiency.
Material and Methods
Between January 2002 and Mai 2009 LNSS for small renal tumour were performed in 38 patients (16 women, 22 men). The indication was renal mass range 2–5 cm (average size of the tumour 3.2 cm). Mean patient age was 52.3 years. All patients underwent CT scan prior operation to take reliable information about size and position of the tumour. Most of tumour were exophytic: upper pole (n = 16), lower pole (n = 14), 6 endophytic and 2 hilar. All the procedures were performed by 2 experienced laparoscopists. In 32 cases was transperitoneal and 6 extraperitoneal fashion.
Results
Mean operative time was 158 minutes (range 75–300). In 36 patients the hilar vessels was clamped. Warm ischemia time was from 15 to 30 minutes, mean 21 minutes. Blood loss was from 50–1000 ml (mean 256 ml). Mean hospital stay was 6.8 days. Hemostasis was achieved with bipolar coagulation. In 25 cases interstitial tissue was closed using a suture, in 5 cases suture with haemostatic bolster (TachoSil®), and only TachoSil® in 8 patients. One patient had open conversion because of hilar location of tumour and technically difficult conditions. In two cases there was positive margins and were finished with nephrectomy. The overall complication rate was 5.5%: postoperative bleeding (n = 1), and urine leak (n = 1). The histological examination demonstrated renal cell carcinoma (n = 26), solitary fibrosus tumour (n = 1), chromophobe carcinoma (n = 1), angiomyolipoma (n = 4), leyomyoma (n = 1), oncocytoma (n = 2) and cyst (n = 3).
Conclusions
Laparoscopic partial nephrectomy is gaining wide spread acceptance as a technique for nephron sparing surgery for small, localized renal tumours. The technique performed in centers with expertise is safe and allows to lower incidence of intra- and postoperative complications. The durability of oncological outcome in our group of patients has to be determined and needs further analysis.
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Copyright
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.
