Laparoscopic nephron sparing surgery: an Australian experience

Background: The objective of this study was to evaluate clinical outcomes from our initial experience with laparoscopic nephron sparing surgery (LNSS) for small renal masses in Australian practice. Methods: A retrospective review was performed on an initial 50 patients undergoing LNSS. All procedures performed between April 2006 and September 2012 were included with median follow-up of 30 months. Outcomes measured were: positive surgical margin, warm ischaemic time, total operative time, blood transfusion and complications in the first 30 days after surgery. Results: The mean age of patients was 57 years. The mean pre-operative creatinine was 85 mu mol/L and the mean post-operative creatinine was 89 mu mol/L. Sixty-four per cent of the tumours were malignant tumours. The mean size of tumours was 2.5 cm. There were two malignant positive surgical margins on histology. The mean total operative time was 224 min and the mean warm ischaemic time was 24 min. Nine patients had complications with Clavien-Dindo grade III or lower. There was no grade IV or V complication. No patients were lost to follow-up and there have been no tumour recurrences to date. Conclusions: LNSS is emerging as a viable alternative to open NSS for small renal tumours with lower morbidity and equivalent oncological and functional outcomes. There is, however, a steep learning curve associated with the procedure.