Laparoscopic nephrectomy: initial experience and 3 years follow-up with 68 cases

Abstract

Introduction : Partial nephrectomy is considered the gold standard procedure in managing small renal masses less than 4cm, even less than 7 cm in the last decade. Minimal invasive surgery is a preferred option in those cases. Laparoscopic partial nephrectomy has equivalent oncological results with open partial nephrectomy, offering in the same time all the advantages of minimal invasive surgery. The purpose of our study is to present our initial experience in laparoscopic partial nephrectomy. Material and Methods : Between May 2015 and December 2017, 68 selected patients with renal masses smaller than 7cm observed by CT scan, were submitted to laparoscopic partial nephrectomy. Patient demographics, preoperative tumor characteristics and detailed operative, postoperative and pathologic data were collected. Results : Mean age of patients is 56,1 years (44-71), mean diameter of renal tumor 5, 3 cm (3,3 - 7,4 cm).36 patients had a right partial nephrectomy and 32 a left one, with no intraoperative complications. In four patients a laparoscopic radical nephrectomy was done, there are no cases of conversion to open surgery. The operation time ranged from 90 to 211 min, estimated blood loss (EBL) ranged from 30 to 300 ml and warm ischemia time (WIT) ranged from 5 to 31 min. Overall, four cases of postoperative complications CDC ≥ 3 were observed. One patient presented with a ureteric stricture and 3 with bleeding which necessitate angiographic intervention. There was one patient with a microscopic positive surgical margin and all patients are disease free during follow up (3-20 months, mean 12,2 months). Mean serum creatinine level has increased 23 mcmol/L (0-114). Conclusion : Laparoscopic partial nephrectomy is a safe and feasible approach in small renal masses, offering all the advantages of minimal invasive surgery