Laparoscopic nephron-sparing surgery for solid renal masses using the ultrasonic shears

Abstract

Objectives. To report our experience with laparoscopic nephron-sparing surgery (NSS) for solid renal masses. Methods. Between August 1998 and December 1999, 15 patients with solid renal masses underwent laparoscopic NSS at our institutions. Seven patients underwent a transperitoneal approach and eight a retroperitoneal approach. The kidneys were fully mobilized to allow inspection of all renal parenchyma. The ultrasonic shears were used to divide the renal parenchyma around the tumor in all cases. Renal surface hemostasis was then accomplished by welding a piece of oxidized regenerated cellulose gauze to the transected renal surface with the argon beam coagulator. Tumors were removed intact and sent for analysis of frozen section margin status. Results. Laparoscopic NSS was successfully completed without complications in all patients. The mean tumor size was 2.3 cm (range 0.8 to 3.5), mean operative time was 170 minutes (range 105 to 240), and mean estimated blood loss was 368 mL (range 75 to 1000). The final pathologic finding was renal cell carcinoma in 12 patients and oncocytoma in 3 patients. All final surgical margins were negative. Patients were hospitalized for a mean of 2.6 days (range 2 to 4). Conclusions. Laparoscopic NSS for small, solid renal masses can be performed safely with a combination of the ultrasonic shears for renal parenchymal transection and argon beam coagulation and oxidized regenerated cellulose gauze for renal surface hemostasis.