PD07-05 THE OUTCOME OF GASLESS LAPAROSCOPIC SINGLE-PORT CLAMPLESS SUTURELESS PARTIAL NEPHRECTOMY USING THREE-DIMENSIONAL HEAD-MOUNTED DISPLAY

Abstract

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy I1 Apr 2018PD07-05 THE OUTCOME OF GASLESS LAPAROSCOPIC SINGLE-PORT CLAMPLESS SUTURELESS PARTIAL NEPHRECTOMY USING THREE-DIMENSIONAL HEAD-MOUNTED DISPLAY Yosuke Yasuda, Kazutaka Saito, Takahiko Soma, Toshiki Kijima, Soichiro Yoshida, Minato Yokoyama, Junichiro Ishioka, Yoh Matsuoka, Kazunori Kihara, and Yasuhisa Fujii Yosuke YasudaYosuke Yasuda More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Takahiko SomaTakahiko Soma More articles by this author , Toshiki KijimaToshiki Kijima More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Minato YokoyamaMinato Yokoyama More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Kazunori KiharaKazunori Kihara More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.438AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Partial nephrectomy (PN) is now the standard treatment for clinically localized renal cancers. Vascular clamping during the tumor resection might induce renal ischemia and reperfusion injury. Renal renorrhaphy could be associated with postoperative pseudoaneurysm. We have performed gasless laparoscopic single-port clampless sutureless PN using a three-dimensional head-mounted display (3D-HMD) system which combines a high-definition 3-D organic electroluminescent HMD with a high-definition 3D endoscope (Kihara K, Int. J. Urol 2015). The tumor is resected in a three-step procedure called the mushroom technique; the three steps are as follows 1) coagulating the resection margin and creating a groove around the tumor, 2) tapering the bottom of the groove to create a “mushroom stalk” shape in the tumor base, and 3) transecting the mushroom stalk. The surgical, oncological and functional outcomes of this surgery are presented. METHODS Between November 2011 and April 2017, consecutive 328 patients with suspected renal cell carcinoma (RCC) underwent gasless laparoscopic single-port PN using 3D-HMD by 21 surgeons. Six patients with metastatic RCC and 11 patients with bilateral RCC were excluded. RESULTS Of the 311 patients, 301 patients (97%) were treated by PN without vascular clamping and parenchymal suture. Median tumor size was 2.5 cm (range 0.9-9.8 cm). The median PADUA score was 8 (range 6-12), and 89 patients (29%) were complex cases (PADUA score = 10). Ninety-three patients (30%) had central tumors and 32 patients (10%) had hilar tumors. Median operative time and blood loss were 225 min and 300ml, respectively. Eight patients (3%) received allogeneic blood transfusions. Twenty-two major complications (7%, all grade 3 urinary leakage) were observed. No patients developed postoperative pseudoaneurysms. Of the 282 RCC patients, eight patients (3%) had positive surgical margins. During the follow-up period (median, 31 months), one patient (0.4%) and four patients (1%) developed bone metastasis and local recurrences, respectively. No patients died of RCC. The median percent decrease in estimated glomerular filtration rate three months after PN was 5.3%. CONCLUSIONS Gasless laparoscopic single-port clampless sutureless PN can be accomplished in almost all cases. This surgery is technically feasible and safe, yielding favorable oncological and functional outcomes. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e158 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Yosuke Yasuda More articles by this author Kazutaka Saito More articles by this author Takahiko Soma More articles by this author Toshiki Kijima More articles by this author Soichiro Yoshida More articles by this author Minato Yokoyama More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...