Approach for Renal Tumors With Low Nephrometry Score Through Unclamped Sutureless Laparoscopic Enucleation Technique: Functional and Oncologic Outcomes

The management of clinical T1 exophytic renal tumors recommends partial nephrectomy or simple enucleation technique for preservation of renal function. We reviewed data of 143 consecutive patients who underwent sutureless laparoscopic tumor enucleation with zero ischemia and analyzed complication rates as well as functional and oncologic outcomes. Simple laparoscopic tumor enucleation has been shown to be a safety technique with low complications and to preserve the largest amount of kidney tissue possible while maintaining the same oncologic outcomes. Purpose: We report an unclamped sutureless laparoscopic simple enucleation (LSE) technique for renal tumors with low nephrometry score and analyze complication rates as well as functional and oncologic outcomes. Patients and Methods: We reviewed the data of 143 consecutive patients who underwent sutureless laparoscopic tumor enucleation with zero ischemia by a single experienced laparoscopic surgeon. The inclusion criteria for LSE with zero ischemia were tumor size <= 5 cm and RENAL nephrometry score of 4 to 6. The following data were collected: age, gender, body mass index, tumor side, renal function, tumor characteristics, American Society of Anesthesiologists score, operative time, positive surgical margins, estimated blood loss, and surgical complications. Results: The median RENAL score of patients was 4.7. Median tumor size was 2.7 cm. Conversion to open surgery and hilum vessels clamped were not necessary in any patient. There were no changes in postoperative creatinine values and estimated glomerular filtration rate. The median operation duration time was 78.2 minutes, and median estimated blood loss was 110.2 mL. The median hospital stay was 3.8 days. A total of 2.8% of the patients had positive surgical margins at pathologic examination. Of the 143 patients, 7% developed fever after surgery requiring an adequate antibiotic regimen, 1.4% developed postoperative bleeding requiring blood transfusions, and 0.7% had postoperative urinary leakage from the drainage requiring double-J stent position. Conclusion: The unclamped sutureless LSE is a rational and safe approach to renal tumors with a low nephrometry score. This surgical technique does not increase the complication rate despite the reduction in parenchymal mass excised and the absence of hilar control. (C) 2018 Elsevier Inc. All rights reserved.