Yonsei Med J.  2012 Jan;53(1):151-157. 10.3349/ymj.2012.53.1.151.

Comparison of Video-Assisted Minilaparotomy, Open, and Laparoscopic Partial Nephrectomy for Renal Masses

• Jeon HG
• Choi KH
• Kim KH
• Rha KH
• Yang SC
• Han WK

• KMID: 1779700
• DOI: http://doi.org/10.3349/ymj.2012.53.1.151

Abstract

PURPOSE
Minimally invasive management of small renal tumors has become more common. We compared the results of partial nephrectomy by video-assisted minilaparotomy surgery (VAMS), open, and laparoscopic techniques.
MATERIALS AND METHODS
We retrospectively compared clinicopathological, oncological, and functional outcomes in 271 patients who underwent partial nephrectomy for renal tumors at one institution from 1993 to 2007; including 138 by VAMS, 102 by open, and 31 by laparoscopic technique.
RESULTS
Mean follow-up was 47.7+/-29.1 months. No statistically significant differences in the three groups were found in tumor size, tumor location, estimated blood loss, complication rate, preoperative glomerular filtration rate (GFR), and GFR at last follow-up. Ischemic time was shorter in the open (26.9 min) and VAMS (29.3 min) groups than in the laparoscopic group (31.0 min, p=0.021). Time to normal diet and hospital stay were shorter in the VAMS (1.8 days and 5.4 days) and laparoscopic (1.8 days and 4.7 days) groups than in the open group (2.4 days and 7.3 days, p=0.036 and p<0.001, respectively). Of 180 patients with cancer, positive surgical margins occurred in 2 of 82 patients (2.4%) in the VAMS group, none of 75 patients in the open group, and 3 of 23 patients (13.0%) in the laparoscopic group (p=0.084). In the VAMS, open, and laparoscopic groups, 5-year disease-free survival was 94.8%, 95.8%, and 90.3% (p=0.485), and 5-year cancer-specific survival was 96.3%, 98.6%, and 100%, respectively (p=0.452).
CONCLUSION
Partial nephrectomy using VAMS technique provides surgical, oncologic, and functional outcomes similar to open and laparoscopic techniques.

Keyword

Partial nephrectomy; renal cell carcinoma; video-assisted surgery; minimally invasive

MeSH Terms

Adult
Aged
Carcinoma, Renal Cell/mortality/*surgery
Female
Humans
Kidney Neoplasms/mortality/*surgery
Laparoscopy/instrumentation/*methods
Laparotomy/instrumentation/*methods
Male
Middle Aged
Nephrectomy/instrumentation/*methods
Retrospective Studies
Treatment Outcome
Video-Assisted Surgery/instrumentation/*methods

Figure

• 

  Fig. 1 (A) The self-retractor system for video-assisted minilaparotomy surgery for partial nephrectomy. (B) A laparoscopic retrieval sac (LapSac®, Sejong, Korea) was introduced through the minilaparotomy incision and placed around the kidney. (C) Laparoscopic bulldog clamps were applied to the renal artery. (D) The LapSac® was dissected in four parts, and ice slush was placed in the LapSac®. Tumor exposure was easily performed by handling these four parts of the LapSac®.

• 

  Fig. 2 Disease-free survival for 180 patients with renal cell carcinoma, stratified by VAMS, open, and laparoscopic techniques for partial nephrectomy (log rank test: VAMS vs. open, p=0.954; VAMS vs. laparoscopic, p=0.257; and open vs. laparoscopic, p=0.310). VAMS, video-assisted minilaparotomy surgery.

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