Application of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for patients with multiple renal tumors

Abstract

Objective To explore the feasibility and safety of retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping for the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency. Methods Seven patients who have undergone retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping between October 2010 and October 2016 were retrospectively analyzed, and clinical materials and parameters during and after the operation were summarized, including operation time, clamping time of segmental renal artery, blood loss during the operation, complications and renal function after the operation. Results Fifteen tumors were resected in 7 patients and the operations were all successful. The operation time ranged from 100 to 180 minutes with the average of 125 minutes; clamping time of segmental renal artery was 10-30 minutes with the average of 23 minutes; the amount of blood loss during the operation was 120-330 ml with the average of 190 ml; hospital stay after the operation is 3-6 d with the average of 5 d. There was no complication during the perioperative period, and the pathology diagnosis after the surgery showed that there were 4 renal clear cell carcinomas, 1 papillary carcinoma and 2 perivascular epithelioid cell tumors and the margins were all negative. All patients were followed up for 3-60 months, and no local recurrence or metastasis was detected, and the creatinine was 102-187 μmol/L at 3 months after operation. Conclusions For the patients with multiple renal tumors and solitary kidney or contralateral kidney insufficiency, retroperitoneal laparoscopic partial nephrectomy with sequential segmental renal artery clamping was feasible and safe, which minimized the hot ischemia injury to the kidney and preserved the renal function effectively. Key words: Kidney neoplasms; Retroperitoneal laparoscopic operation; Partial nephrectomy; Segmental renal artery; Sequential clamping