Retroperitoneal Laparoscopic Partial Nephrectomy Research Articles

Comparison of the Clinical Efficacy of Retroperitoneal Laparoscopic Partial Nephrectomy and Radical Nephrectomy for Treating Small Renal Cell Carcinoma: Case Report and Literature Review.

BackgroundRenal cell carcinoma (RCC) is a common malignancy of the urinary system with high rates of morbidity and mortality.ObjectivesThis study aimed to investigate and analyze the clinical efficacy of retroperitoneal laparoscopic partial nephrectomy and laparoscopic radical nephrectomy for the treatment of small RCC.MethodsIn this retrospective study of 45 patients with small RCC, the patients were divided into two treatment groups: Group A (retroperitoneal laparoscopic partial nephrectomy, 25 cases) and Group B (retroperitoneal laparoscopic radical nephrectomy, 20 cases).ResultsThere were no statistically significant differences in the operative time, amount of intraoperative blood loss, length of hospital stay, preoperative creatinine level, postoperative creatinine level after 24 hours, and survival rate after 1, 2, and 3 years between the two groups (P > 0.05).ConclusionsThere were no significant differences in the survival rates and short-term postoperative complications between the laparoscopic partial nephrectomy group and the laparoscopic radical nephrectomy group for small RCC, but the former was slightly more effective.

Retroperitoneal laparoscopic partial nephrectomy for treatment of metanephric adenoma (Report of 6 cases).

ObjectivesTo investigate the clinical and pathological features of metanephric adenoma (MA) and the clinical outcome after retroperitoneal laparoscopic nephron-sparing surgery.MethodsSix out of 183 partial nephrectomies performed during January 2009 to August 2014 were confirmed to be MA confirmed by postoperative pathological study. Perioperative parameters of the six patients were then retrospectively collected, analyzed and compared with current literature, including warm ischemia time (WIT), total operation time, estimated blood loss (EBL), positive surgical margin (PSM), and complications. Surgical and oncological outcome of all six patients were evaluated based on a mean follow up of 17 months (5–48 months).ResultsTumors in all six cases were all successfully removed by partial nephrectomy. Mean WIT was 24.7 min (19–35 min). Mean operation time was 103.6 min (82–147 min). Mean EBL was 53.5 ml (20–85 ml). No conversion, transfusion or other major complication were observed in all six cases. Postoperative pathology confirmed negative surgical margin in all six cases. During a mean of 17 month follow up (5–48 months), no local recurrence or metastasis were found in all six cases.ConclusionMA is a rare benign primary kidney epithelial cancer, which could hardly be differentiated from renal malignancies based on preoperative imaging. Our data suggested that retroperitoneal laparoscopic partial nephrectomy can be used for surgical treatment of MA, in terms of tumor control and preservation of renal function.

AB054. Learning curve and RENAL score co-affect the outcomes of retroperitoneal laparoscopic partial nephrectomy

ObjectiveTo report our laparoscopic partial nephrectomy (LPN) experience and assess the role of learning curve and RENAL score impact on the outcomes of LPN, focusing on shortening the procedure time and preventing complications.MethodsAll 90 cases of retroperitoneal LPN performed by a single surgeon from June 2010 to December 2012 were enrolled. To assess learning curve effect the outcomes of LPN, 90 cases were divided into three groups (LPN A, LPN B, LPN C) of 30 cases based on when they occurred. To evaluate RENAL score impact on the outcomes of LPN, 90 cases were divided into three groups (high, mid, low) based on RENAL score. Outcomes were analyzed the following: operative time (OT), warm ischemia time (WIT), operative blood loss (OBL), perioperative complications, change of serum creatinine (△SCr) and change of GFR (△GFR).ResultsOT (LPN A 153.67±18.10 min, LPN B 146.00±16.94 min, LPN C 141.35±17.76 min, P=0.027), WIT (LPN A 38.03±4.76 min, LPN B 35.50±4.47 min, LPN C 31.60±5.28 min, P<0.001), and OBL (LPN A 184.33±31.25 mL, LPN B 164.33±27.38 mL, LPN C 142.00±27.22 mL, P<0.001) decreased with increasing surgeon experience. OT (high 164.00±19.57 min, mid 147.06±18.18 min, low 140.73±13.30 min, P<0.001), WIT (high 37.00±5.50 min, mid 33.12±5.22 min, low 30.80±3.93 min, P<0.001) and △SCr (high 0.06±0.04 mg/dL, mid −0.02±0.15 mg/dL, low 0.00±0.04 mg/dL, P=0.026) were inversely correlated with RENAL score. RENAL score also affect the outcomes of each LPN eras. Eleven complications were observed in 11 cases (11/90, 12.2%), Complications rate were similar with LPN A (5/30, 16.7%), LPN B (3/30, 10%) and LPN C (3/30,10%) P=0.780. However, there were significant differences between high REANL score (5/15, 33.3%), mid RENAL score (3/34, 8.8%) and low RENAL score (3/41, 7.8%) P=0.034. When considering the effects of both LPN eras and RENAL score, no synergistic effects were observed.ConclusionsLearning curve and RENAL score impact on the outcomes of retroperitoneal laparoscopic partial nephrectomy were independent, and RENAL score also influence the outcomes of each LPN ears. We can select the appropriate cases based on the REANL score in the early stage of LPN may contribute to shortening the procedure time and preventing complications.

Comparison of transperitoneal and retroperitoneal approach in robotic-assisted laparoscopic partial nephrectomy

Objective To compare the peri-operative outcomes of patients who underwent transperitoneal or retroperitoneal robotic-assisted laparoscopic partial nephrectomy (RALPN). Methods From September 2014 to June 2015, 103 patients with kidney neoplasms who underwent RALPN were retrospectively analyzed, including 64 males and 39 females. Their mean age was 52 years(24-80 years). Forty-four cases (29 male, 15 female) were in transperitoneal group and 59 (35 male, 24 female) in retroperitoneal group according to tumor location. The tumor size was (3.8±2.3) cm in transperitoneal group and (3.3±1.4) cm in retroperitoneal group. Results Warm ischemia time (WIT) was (23.5±5.3) min in transperitoneal group and (19.1±6.9) min in retroperitoneal group (P>0.05). WIT of dorsal mass was (26.3±6.0) min and (19.4±6.5) min (P>0.05), operation duration was (127.1±31.3) min and (91.2±24.1) min (P 0.05), and bowel recovery time was 2.2 days (2-4 days) and 1.3 days (1-2 days) (P<0.05), respectively. The operation duration, WIT of dorsal mass and bowel recovery time were obviously less in retroperitoneal group than those in transperitoneal group. Conclusions Both transperitoneal and retroperitoneal approach of RALPN were effective and safe for kidney neoplasms patient treatment. Compared with transperitoneal approach, retroperitoneal method could greatly shorten operation time, WIT of dorsal mass and bowel recovery time. Key words: Robotics; Retroperitoneal; Kidney neoplasms; Partial nephrectomy

Laparoscopic partial nephrectomy for non-functional lower pole kidney stone.

We present a retroperitoneal laparoscopic partial nephrectomy video for a non-functional obstructed lower pole with multiple renal stones. A 41-year-old female was admitted to our urology clinic with left-sided flank pain. The radiologic imaging (CT and IVP) revealed multiple left renal stones localized in the pelvis, middle and lower calyces. We performed percutaneous nephrolithotomy and roboflex assisted flexible ureterorenoscopy twice in two months resulting in removal of most of the stone load. Left kidney function on scintigraphy was 20%. Ultrasonography and computerized tomography of the abdomen revealed multiple left lower pole renal stones with a severely dilated lower calyx. The pyelography showed no connection between the collecting system and this non-functional calyceal system due to the high stone load. We performed a laparoscopic retroperitoneal three-port partial nephrectomy with stone extraction. The operative time was 59 minutes. The patient was discharged on day five without complications. Histopathology revealed atrophic renal parenchyma without any malignancy. Laparoscopic retroperitoneal partial nephrectomy might be a safe and an effective method in a non-functional lower pole calyx with a high stone load.

Ring Suture Technique in Retroperitoneal Laparoscopic Partial Nephrectomy for Hilar Cancer: A New Renorrhaphy Technique

To evaluate the safety and efficacy of a ring suture technique during retroperitoneal laparoscopic partial nephrectomy (RLPN) for management of renal cell carcinoma (RCC) in the renal hilum. Data for patients with renal hilar cancer who underwent RLPN from January 2010 to March 2015 were collected. All surgeries involved the ring suture technique, following the same procedure: the renal artery was dissected and clamped, the tumor was enucleated from the kidney, defects of the vascular and collecting system were repaired, and then the edge of the renal parenchyma was sutured continuously along the border. Finally, the renal artery clamp was removed, and any injury of the vascular system was repaired if necessary. We retrospectively analyzed renal ischemic time, blood loss, and postoperative complications. Among the 17 patients, 11 were male (median age 61 years, range 42-71 years). Mean tumor diameter was 3.4 ± 0.9 cm and median R.E.N.A.L. nephrometry score was 8 (range 6-10). The mean warm ischemic time was 23.0 ± 9.2 minutes and median blood loss during surgery was 110 mL (range 70-350 mL); we had no case of uncontrollable massive bleeding. Radical nephrectomy was used in one case because of tumor embolus in a branch of the renal vein. All patients recovered well following surgery. Pathology confirmed the diagnosis of RCC in all cases, with the main subtype clear-cell carcinomas (88.2%). The ring suture technique is safe and effective for management of renal hilar cancer during RLPN for selected patients.

Retroperitoneal Versus Transperitoneal Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-analysis

To review published literatures comparing the safety and effectiveness of retroperitoneal laparoscopic partial nephrectomy (RLPN) with transperitoneal laparoscopic partial nephrectomy (TLPN) and provide reference for clinical work. The search strategy was performed to identify relevant papers from the Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, Google Scholar, China Hospital Knowledge Database, Wangfang Chinese Periodical Database, and VIP Chinese Periodical Database. All papers comparing RLPN with TLPN were included from 2000 to 2015. Two to three reviewers independently screened, evaluated, and extracted the included papers. A Meta-analysis was executed by using Review Manager 5.3 software. The interesting outcomes were tumor size, operating time, estimated blood loss, warm ischaemia time, length of hospital stay, positive margin rate, open conversion rate, overall complication rate, and recurrence rate. The literature search obtained 378 papers, then 10 of them were ultimately met the inclusion criteria and included in the systematic review. Finally, 6 of the 10 papers were included in the Meta-analysis. RLPN had significantly less operating time [P = 0.01, mean difference (MD)=-33.68, 95% confidence interval (CI) within (-60.35, -7.01)] and shorter length of hospital stay [P < 0.0001, MD=-1.47, 95% CI within (-2.18, -0.76)] than TLPN. Significant differences were not found between RLPN and TLPN in other outcomes. RLPN may be equally safe and be faster than TLPN. Each center can choose a modality according to your own operating habits and experience.

Outcomes of retroperitoneal laparoscopic partial nephrectomy in patients with endophytic renal tumors

Objective To compare the perioperative outcomes and postoperative complications of retroperitoneal laparoscopic partial nephrectomy (RLPN) for the treatment of endophytic renal tumors and non-endophytic tumors. Methods Three hundred and ninety-two patients who underwent RLPN for kidney neoplasms from May 2005 to September 2012 were retrospectively analyzed. They were divided into endophytic renal tumor group (48 cases) and non-endophytic tumor group (344 cases). There were no significant differences in the aspects of gender, age, body mass index, tumor side, diameter, preoperative estimated glomerular filtration rate (eGFR) between the two groups. Operative time, warm ischemia time, method of renal vascular occlusion, repair rate of renal collecting system, estimated blood loss, usage of laparoscopic ultrasonography, intraoperative complications, pathological types, postoperative hospitalization days, postoperative complications and postoperative eGFR were collected and analyzed. Results Patients with endophytic tumors had significantly more usage of laparoscopic ultrasonography (95.8% versus 1.2%, P 0.05) between the 2 groups. All the patients' surgical margins were negative. The rates of postoperative complication (Clavien grade Ⅰ to Ⅲb) were 4.2% and 2.9% in the endophytic group and non-endophytic group, respectively (P>0.05). Median follow-up was 42 (33-108) months in endophytic group and 45 (33-120) months in non-endophytic group. No local recurrence or metastasis occurred in the two groups. Conclusions In experienced hands, RLPN could represent a feasible, safe and effective treatment for selected patients diagnosed with endophytic renal tumors.Laparoscopic ultrasonography is valuable on locating the tumor and defining tumor margins in RLPN of endophytic renal tumors. Key words: Laparoscopes; Partial nephrectomy; Kidney neoplasms; Retroperitoneal

The Application of "Renal Pedicle Rotation" Method in Retroperitoneal Laparoscopic Partial Nephrectomy for Renal Ventral Tumors.

To present preliminary experience of "renal pedicle rotation" method in retroperitoneal laparoscopic partial nephrectomy (RLPN) for renal ventral tumors. A retrospective analysis of renal surgery database about patients undergoing RLPN was conducted. We identified 14 consecutive cases of all the surgeries from December 2013 to October 2014 with renal ventral tumors. The 14 surgeries were all in the application of renal pedicle rotation method, an intraoperative skill in which surgeons rotates the kidney on renal pedicle axis after separating renal artery and vein for a better tumor exposure. A total of 14 patients underwent RLPN. All surgeries were successful without conversion to radical nephrectomy or open partial nephrectomy. The mean operative time was 171.1±47.2 min (range 83-246), the mean warm ischemia time was 15.9±9.8 min (range 7-35) and the mean estimated blood loss was 89.3±102.2 mL (range 10-300). Mean postoperative hospital stay was 6.2±1.9 days (range 4-10) and mean retroperitoneal drainage was 4.2±1.4 days (range 2-8). No intraoperative complications occurred. Postoperative complications developed in four patients. All patients had negative margins and pathological examination revealed 10 (71.4%) clear cell carcinomas, two (14.2%) epithelial renal angiomyolipoma, one (7.1%) papillary carcinoma and one (7.1%) nephrotuberculosis. The review of the early oncologic outcomes revealed no local recurrence and distant metastasis. The renal pedicle rotation method might be a feasible and safe procedure to get a better tumor exposure for incision and suture in renal ventral tumors RLPN surgeries with acceptable postoperative outcomes.

Stone component analysis of 1000 patients in yi-lan county

Stone component analysis of 1000 patients in yi-lan county

Preoperative planning and real-time assisted navigation by three-dimensional individual digital model in partial nephrectomy with three-dimensional laparoscopic system.

To evaluate the feasibility and effectiveness of preoperative planning and real-time assisted surgical navigation for three-dimensional laparoscopic partial nephrectomy under the guidance of three-dimensional individual digital model (3D-IDM) created using three-dimensional medical image reconstructing and guiding system (3D-MIRGS). Between May 2012 and February 2014, 44 patients with cT1 renal tumors underwent retroperitoneal laparoscopic partial nephrectomy (LPN) using a three-dimensional laparoscopic system. The 3D-IDMs were created using the 3D-MIRGS in 21 patients (3D-MIRGS group) between February 2013 and February 2014. After preoperative planning, operations were real-time assisted using composite 3D-IDMs, which were fused with two-dimensional retrolaparoscopic images. The remaining 23 patients underwent surgery without 3D-MIRGS between May 2012 and February 2013; 14 of these patients were selected as a control group. Preoperative aspects and dimensions used for an anatomical score, "radius; exophytic/endophytic; nearness; anterior/posterior; location" nephrometry score, tumor size, operative time (OT), segmental renal artery clamping (SRAC) time, estimated blood loss (EBL), postoperative hospitalization, the preoperative serum creatinine level and ipsilateral glomerular filtration rate (GFR), as well as postoperative 6-month data were compared between groups. All the SRAC procedures were technically successful, and each targeted tumor was excised completely; final pathological margin results were negative. The OT was shorter (159.0 vs. 193.2 min; p < 0.001), and EBL (148.1 vs. 176.1 mL; p < 0.001) was reduced in the 3D-MIRGS group compared with controls. No statistically significant differences in SRAC time or postoperative hospitalization were found between the groups. Neither group showed any statistically significant increases in serum creatinine level or decreases in ipsilateral GFR postoperatively. Preoperative planning and real-time assisted surgical navigation using the 3D-IDM reconstructed from 3D-MIRGS and combined with the 3D laparoscopic system can facilitate LPN and result in precise SRAC and accurate excision of tumor that is both effective and safe.

Editorial Comment to Evolving renorrhaphy technique for retroperitoneal laparoscopic partial nephrectomy: Single‐surgeon series

Editorial Comment to Evolving renorrhaphy technique for retroperitoneal laparoscopic partial nephrectomy: Single‐surgeon series

Application of retroperitoneal laparoscopic partial nephrectomy in the treatment of unilateral multifocal renal tumors

Objective To discuss the safety and efficacy of retroperitoneal laparoscopic partial nephrectomy in the treatment of unilateral multifocal renal tumors.Methods The data of 12 patients with unilateral multifocal renal tumors managed with retroperitoneal laparoscopic partial nephrectomy between 2009 and 2012 were reviewed retrospectively.The 12 patients had a mean age of 42 years (28 to 62) and body mass index of 23.5 kg/m2 (18.6 to 29.3),including 4 males and 8 females.Four cases were in the left side,7 cases were in the right side,and 1 case had bilateral renal tumors.The diameter of renal tumors ranged from 0.5 cm to 4.7 cm,and all tumors were projected on the surface of kidney.Nine cases were diagnosed as renal cell carcinoma,and 3 cases were diagnosed as angiomyolipoma before operation.All patients underwent retroperitoneal laparoscopic partial nephrectomy under general anesthesia,while 1 patient with bilateral renal tumors experienced radical nephrectomy of the contralateral renal tumor 3 months after the first operation.Results All the oprations were successful without conversion to open surgery.The mean renal artery cut off time,operative time,estimated blood loss and hospital stay were 36 min (26-60),126 min (75-184),142 ml (50-300) and 5 d (3-9),respectively.No complication occurred and 1-week postoperative serum creatinine was (78.1 ±8.1)μmol/L.Histopathological study revealed 9 cases of renal cell carcinomaand 3 cases of angiomyolipoma.During the follow-up for 33 months (13-51),1 patient with yon Hippel-Lindau syndrome was operated with ipsilateral radical nephrectomy for a local recurrence while the remains had no local recurrence or metastasis.Conclusions For localized and exogenous unilateral multifocal renal tumors,retroperitoneal laparoscopic partial nephrectomy is feasible and safe.Those who have hereditary and/or malignant renal tumors should be monitored closely. Key words: Kidney neoplasms; Multifocal; Multicentricity; Laparoscopes

Transperitoneal Approach versus Retroperitoneal Approach: A Meta-Analysis of Laparoscopic Partial Nephrectomy for Renal Cell Carcinoma

ObjectiveTo compare the efficiency and safety of the transperitoneal approaches with retroperitoneal approaches in laparoscopic partial nephrectomy for renal cell carcinoma and provide evidence-based medicine support for clinical treatment.MethodsA systematic computer search of PUBMED, EMBASE, and the Cochrane Library was executed to identify retrospective observational and prospective randomized controlled trials studies that compared the outcomes of the two approaches in laparoscopic partial nephrectomy. Two reviewers independently screened, extracted, and evaluated the included studies and executed statistical analysis by using software STATA 12.0. Outcomes of interest included perioperative and postoperative variables, surgical complications and oncological variables.ResultsThere were 8 studies assessed transperitoneal laparoscopic partial nephrectomy (TLPN) versus retroperitoneal laparoscopic partial nephrectomy (RLPN) were included. RLPN had a shorter operating time (SMD = 1.001,95%confidence interval[CI] 0.609–1.393,P<0.001), a lower estimated blood loss (SMD = 0.403,95%CI 0.015–0.791,P = 0.042) and a shorter length of hospital stay (WMD = 0.936 DAYS,95%CI 0.609–1.263,P<0.001) than TLPN. There were no significant differences between the transperitoneal and retroperitoneal approaches in other outcomes of interest.ConclusionsThis meta-analysis indicates that, in appropriately selected patients, especially patients with intraperitoneal procedures history or posteriorly located renal tumors, the RLPN can shorten the operation time, reduce the estimated blood loss and shorten the length of hospital stay. RLPN may be equally safe and be faster compared with the TLPN.

Clinical research of retroperitoneal laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ

Objective To establish a new retroperitoneal laparoscopic technique which can keep the kidney in cold ischemia and has the characteristics of safety,effective and simplicity.Methods Twenty-two patients who needs to do the retroperitoneal laparoscopic partial nephrectomy were divided into two groups:the research group and the control group.There were 12 males and 10 females with average age of 37-69 years old.There were 4 cases of angiomyolipoma,and 18 cases of renal cell carcinoma.In research group,the renal temperature was reduced by circumfusion system of ice saline after clamping the renal artery,and then the retroperitoneal laparoscopic partial nephrectomy was done.In the control group,we did the same as well except the renal hypothermia.The renal temperature and the rectal temperature during the surgery,and the glomerular filtration rate (GFR) of both bilateral kidneys and the affected kidney before and after the surgery were compared.Results All the surgical operations were done successfully in both groups.No post-operative bleeding,inflammation and leakage of urine occurred.In the research group,the average cold ischemia time was (47.2 ±3.8) min,the average minimum renal temperature was (17.73 ± 0.91),and the average time reducing the renal temperature to 25 ℃ was (4.6 ±0.4) min.In the control group,the average cold ischemia time was (27.8 ± 1.5) min,and the average minimum renal temperature was (38.08 ± 0.33)℃.In the research group,the average GFR of the bilateral kidneys and the affected kidneys was (66.24 ±3.98) and (30.57 ±4.07) ml/min one week before the surgery,that was 53.89 ±7.53 and (20.92 ±4.49) ml/min one month after the surgery,that was (54.49 ±7.92) and (21.63 ±5.21) ml/min 3 months after the surgery,and that was (54.77 ± 7.84) and (21.73 ± 9.99) ml/min 6 months after the surgery,respectively.In the control group,the average GFR of th bilateral kidneys and the affected kidney was 66.49 ±9.87 and (30.65 ±5.45) ml/min one week before the surgery,that was (54.89 ±9.61) and (17.90 ±3.50) ml/min one month after surgery,that was (55.68 ± 10.02) and (18.09 ±3.39) ml/min 3 months after the surgery,and that was 55.82 ±5.12 and (18.17 ±3.39) ml/min 6 months after the surgery,respectively.The follow-up duration was 1-16 months without local recurrence and metastasis.Conclusion The new equipment with circumfusion system of ice saline can keep the kidney in cold ischemia,and is easy-to-use and efficient,especially it doesn' t need special equipment so it can be widely used in retroperitoneal laparoscopic surgery. Key words: Laparoscopy ; Partial nephretomy; Cold ischemia

Robotic versus traditional laparoscopic partial nephrectomy: comparison of outcomes with a transition of techniques.

We aimed to evaluate the effect of a transition from laparoscopic partial nephrectomy (LPN) to robotic-assisted laparoscopic partial nephrectomy (RALPN) on peri-operative and oncological patient outcomes. We present the results of the last 50 LPN (group 1) compared with our first 50 RALPN (group 2). The peri-operative data was evaluated using appropriate comparison tests. The parameters compared included operative times, warm ischaemia time (WIT), estimated blood loss (EBL), complications using the Clavien-Dindo (CD) grading system and oncological outcomes including positive surgical margin (PSM) rates. Patients in group 1 (n=50) and group 2 (n=50) had comparable pre-operative RENAL scores, ASA scores and tumour size characteristics. Ninety-four percent of the patients in group 1 underwent retroperitoneal LPN while 96% of patients in group 2 underwent transperitoneal RALP. The mean total operative time in groups 1 and 2 was 163 versus 195min, respectively (p=0.003), and EBL was 294 versus 187ml (p<0.001). There was no statistically significant difference in WIT between groups 1 and 2 (24.7 and 21.8min, respectively, p=0.18). Post-operative histology was comparable in the two groups and the PSM rate was 8 versus 4% (p=0.58). The CD major complication rate was 16% in group 1 versus 4% in group 2 (p<0.001). In our series, RALPN appears to have a longer initial total operative time than LPN; however, this reduces after the first 20 cases. RALP has a significant reduction in EBL and post-operative major complication rates, including immediate peri-operative complication rates such as the risk of acute haemorrhage or urinoma. Our data indicates that it is safe to change from LPN to RALPN with no compromise in patient safety or oncological outcomes.

Metachronous occurrence of ipsilateral renal cell carcinoma treated with retroperitoneal laparoscopic non-ischemic partial nephrectomy using microwave tissue coagulator after retroperitoneal non-ischemic open partial nephrectomy：A case report

Metachronous occurrence of ipsilateral renal cell carcinoma treated with retroperitoneal laparoscopic non-ischemic partial nephrectomy using microwave tissue coagulator after retroperitoneal non-ischemic open partial nephrectomy：A case report

Comparison of two different renorrhaphy techniques in retroperitoneal laparoscopic partial nephrectomy for complex tumor

Background Partial nephrectomy is currently the standard treatment for clinical T1 renal neoplasms, as it can provide oncologic outcomes equivalent to radical nephrectomy. The aim was to evaluate the efficacy of self-retaining suture (SRS) in renorrhaphy technique in retroperitoneal laparoscopic partial nephrectomy (LPN) for a single renal mass of moderate or high complexity by assessing peri-operative outcomes. Methods A retrospective analysis was done of 64 patients between 2010 and 2012 for complex renal mass (RENAL score ≥7) in whom retroperitoneal LPN was performed with two layers using continuous knotless barbed suture (Quill PDO SRS group; n=34) and absorbable vicryl (non-SRS group; n=30), respectively. Cases were matched for RENAL score. All the surgical procedures were performed by the same surgeon with experience of more than 500 cases of LPN. Comparisons were made in patients and preoperative outcomes and peri-operative complications between SRS group and non-SRS group. Results Mean warm ischemia time (WIT) in SRS group was less than non-SRS group (18.0 vs. 24.8 minutes, P=0.021). Renorrhaphy suture cost in SRS group was lower than non-SRS group ($269.6 vs. $335.8, P=0.001). There were no significant differences between the two groups for postoperative changes in creatinine and estimated glomerular filtration rate and the rate of peri-operative complications. Conclusion SRS was safe for complex renal tumor with two layers, continuous and unknot suture, during LPN and would reduce the WIT and renorrhaphy suture cost significantly.

Retroperitoneal laparoscopic partial nephrectomy combined with auxiliary small-incision and real-time B ultrasonic imaging in treatment of central renal cell carcinoma: a report of 12 cases

Retroperitoneal laparoscopic partial nephrectomy combined with auxiliary small-incision and real-time B ultrasonic imaging in treatment of central renal cell carcinoma: a report of 12 cases

Retroperitoneal laparoscopic partial nephrectomy in patients with tumors larger than 4 cm

Objective To compare the perioperative outcomes and early postoperative complications of retroperitoneal laparoscopic partial nephrectomy to treat renal cell carcinoma in patients with tumor ＞4.0 cm and those with tumor ≤4.0 cm.Methods Three hundred and fifty-eight patients who had undergone retroperitoneal laparoscopic partial nephrectomy for renal cell carcinoma from June 2005 to June 2012 were retrospectively analyzed.The mean diameter of the renal tumors was 2.8 cm (range 0.7-7.9 cm).The clinical factors (i.e.gender,age,tumor characteristics),perioperative course (i.e.,operative time,warm ischemia time,estimated blood loss,and length of hospitalization),and early postoperative complications were collected and compared between the patients with tumor burdens ＞4.0 cm compared with those with tumor burdens of ≤4.0 cm.Results All the patients' surgical margins were negative.Patients with larger tumors had significantly greater tumor grades (P =0.017),collecting system repairing (72.5％ versus 34.9％,P=0.000),more intraoperative (13.7％ versus 3.9％,P=0.002) and postoperative complications (13.7％ versus 2.0％,P=0.000) and a significantly longer hospitalization (13.1±5.3 d versus 10.7±8.1 d,P=0.008).No other significant differences including warm ischemia time were noted between the 2 groups stratified by tumor size.Conclusion Retroperitoneal laparoscopic partial nephrectomy could be a feasible option for tumor burdens ＞4.0 cm to provide a nephron-sparing option for patients in whom lesions can be resected by individually assessed. Key words: Laparoscopes; Partial nephrectomy; Kidney neoplasms; Retroperitoneal