Laparoscopic partial nephrectomy in renal cell cancer -: Indications, technique, and outcome in 80 patients

Objectives: Laparoscopic partial nephrectomy (LPN) is emerging as an attractive, minimally invasive, nephron-sparing technique for selected renal tumors. We report our technique and outcome involving the experience of three different surgeons. Patients and methods: Between March 2001 and June 2005, 80 patients underwent transperitoneal LPN for exophytic tumors. Mean age was 58 yr (range: 30-79). Median tumor size was 2.6 cm (range: 0.5-8.5). In 64 cases the renal artery was clamped with endoscopic bulldog clamps. Hemostasis was achieved by application of FloSeal; lesions of the collecting system were closed with Lahodny sutures in 33 cases (31%). Frozen sections were obtained in all cases to document margin status. Results: All 80 procedures were successful with no intraoperative complications. Mean surgical time was 203 min (range: 110-355); clamping time was 20 min (range: 6-75) in 64 cases. In 33 cases the collecting system was opened and required laparoscopic suturing. Margins were negative in 72 cases, in 6 cases secondary resection was necessary to achieve negative margin status, and in 2 cases radical nephrectomy was performed. In 2 cases relaparoscopy was performed for infected hematoma and suspected bleeding. Prolonged extravasation of the collecting system was treated conservatively with a double-J stent in 2 cases. At a mean follow-up of 28 mo (range: 7-62), no recurrence was observed. Conclusions: LPN using FloSeal is a feasible and safe method for treatment of small renal masses. The technique is reproducible by surgeons accustomed to complex laparoscopic procedures. Patient outcome was comparable with data published for open standard procedures. (c) 2007 European Association of Urology. Published by Elsevier B.V. All rights reserved.