Laparoscopic partial nephrectomy in the presence of multiple renal arteries

OBJECTIVES As experience with laparoscopic partial nephrectomy (LPN) expands, inevitably tumor-bearing kidneys with anomalous renal vasculature will be subjected to LPN. We evaluated LPN in kidneys with multiple arteries and compared those outcomes with the LPN outcomes in patients with conventional renal arterial anatomy. METHODS Since September 1999, we have performed LPN for tumors in 333 patients. From this prospectively maintained database, we identified 60 patients with multiple renal arteries and 273 patients with a single renal artery to the operated kidney. All patients underwent three-dimensional computed tomography preoperatively for accurate delineation of the tumor and renal vascular anatomy. The clinical and operative data were reviewed to assess critical outcomes. RESULTS The baseline parameters, including tumor size (P = 0.87), were similar in the two groups. Intraoperatively, the method of vascular control, tumor parenchymal extension depth (P = 0.40), number requiring pelvicaliceal repair (P = 0.62), and specimen weight (P = 0.49) were similar between the two groups. Similarly, the warm ischemia time (P = 0.60), operative time (P = 0.15), blood loss (P = 0.37), and intraoperative (P = 0.52), postoperative (P = 0.48), and late complication (P = 0.64) rates were similar between the two groups. CONCLUSIONS LPN can be efficaciously performed in the presence of multiple renal vessels. Preoperative evaluation with three-dimensional computed tomography is recommended to have preoperative knowledge of the renal vasculature and thereby minimize iatrogenic injury.