Simplified hemostatic technique during laparoscopic partial nephrectomy

INTRODUCTION: Laparoscopic partial nephrectomy (LPN) has gained popularity in recent years, although it remains a challenging procedure. Herein we describe our technique of renal defect closure using sutures as the sole means of hemostasis during LPN. SURGICAL TECHNIQUE: The kidney is approached transperitoneally in a standard fashion. After the renal artery is clamped and the tumor has been excised, the defect is closed in two separate knot-free suture layers. The deep layer suture is continuous and involves deep parenchyma including the collecting system, if opened. The superficial layer suture approximates the margins of the defect using absorbable clips on one parenchymal edge only. No bolsters, glues or other additional hemostatic agents are used. RESULTS: At present this technique was applied in 34 patients. Tumor size ranged from 17-85 mm. Median warm ischemia time was 23 min (range 12-45) and estimated blood loss 55 mL (30-1000). There were no intraoperative complications or conversions to open surgery. No urine leaks or postoperative bleedings were observed. CONCLUSIONS: This simplified technique appears reliable and quick, and therefore may be attractive for many urologic surgeons. Furthermore, the avoidance of routine use of additional hemostatic maneuvers may provide an economical advantage to this approach with no compromise of the surgical outcome

Laparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes

ABSTRACT Purpose: To assess and report the outcomes of laparoscopic partial nephrectomy) LPN) for T2 renal masses. Materials and Methods: Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variables (operative time, warm ischemia time (WIT), estimated blood loss (EBL), intra-operative and postoperative complications (IOC and POC) and pathologic variables (pathology, subtype and Fuhrman grade). Results: A total of 27 patients underwent LPN for a T2 renal mass at our institution between 2005 and early 2016 of which 19 were males. The mean age was 66 (52-72). All procedures were transperitoneal with 16 on the right and 11 on the left. Median operative time was 200 minutes (IQR 181-236) and median WIT 19 minutes (IQR 16-23). EBL was 125mL (IQR 75-175). One case was converted to laparoscopic radical nephrectomy due to suspected tumor thrombus in the renal vein. Surgical margins were positive in one renal tumor in a patient with multiple tumors. There was a total of 2 IOC (7.4%) and 3 POC (11%) classified as Clavien grade 3. Conclusions: To our knowledge, this series is the first to describe the outcomes of LPN for cT2 renal masses. In our series, LPN for larger renal masses appears feasible with favorable perioperative outcomes. Additional data are needed to further explore the benefits of minimally invasive surgical approaches to larger renal masses

Laparoscopic partial nephrectomy for tumors 7cm and above. Perioperative outcomes

<div><p>ABSTRACT Purpose: To assess and report the outcomes of laparoscopic partial nephrectomy) LPN) for T2 renal masses. Materials and Methods: Retrospective review of patients undergoing LPN for clinically localized renal masses ≥7cm between the years 2005-2016. Descriptive analyses were generated for demographics, lesion characteristics, perioperative variables (operative time, warm ischemia time (WIT), estimated blood loss (EBL), intra-operative and postoperative complications (IOC and POC) and pathologic variables (pathology, subtype and Fuhrman grade). Results: A total of 27 patients underwent LPN for a T2 renal mass at our institution between 2005 and early 2016 of which 19 were males. The mean age was 66 (52-72). All procedures were transperitoneal with 16 on the right and 11 on the left. Median operative time was 200 minutes (IQR 181-236) and median WIT 19 minutes (IQR 16-23). EBL was 125mL (IQR 75-175). One case was converted to laparoscopic radical nephrectomy due to suspected tumor thrombus in the renal vein. Surgical margins were positive in one renal tumor in a patient with multiple tumors. There was a total of 2 IOC (7.4%) and 3 POC (11%) classified as Clavien grade 3. Conclusions: To our knowledge, this series is the first to describe the outcomes of LPN for cT2 renal masses. In our series, LPN for larger renal masses appears feasible with favorable perioperative outcomes. Additional data are needed to further explore the benefits of minimally invasive surgical approaches to larger renal masses.</p></div