Korean J Urol.  2009 Aug;50(8):774-779. 10.4111/kju.2009.50.8.774.

Tumor Exposure and Cold Ischemia Using a LapSac(R) in Partial Nephrectomy by Video-Assisted Minilaparotomy Surgery (VAMS)

• Kim KH
• Jeon HG
• Yang SC
• Han WK

• KMID: 1780481
• DOI: http://doi.org/10.4111/kju.2009.50.8.774

Abstract

PURPOSE
We report a new method of tumor exposure through a minilaparotomy window and cold ischemia using a LapSac(R) during partial nephrectomy by video-assisted minilaparotomy surgery (VAMS). MATERIALS AND METHODS: Partial nephrectomy was performed by VAMS in a total of 31 patients during a period ranging from January 2004 to June 2006, and tumor exposure and cold ischemia were achieved by using a LapSac(R). We investigated the tumor size and location, mean operative time, mean estimated blood loss, mean cold ischemic time, and pathologic outcomes retrospectively. We evaluated preoperative and postoperative renal function with the estimated creatinine clearance rate by the MDRD equation. RESULTS: The mean tumor size was 2.59+/-1.30 cm and mean surgical time was 182.5+/-44.5 minutes. Mean cold ischemic time was 31.84+/-8.43 minutes. Mean estimated blood loss was 445.65+/-202.77 ml (range, 100-800 ml), and 3 patients required transfusion. A histopathologic examination confirmed a diagnosis of renal cell carcinoma in 22 patients (71%). The surgical margin was positive in 1 patient. Twenty-one patients had a mean follow-up of 53+/-8.19 months. Nineteen patients survived without any disease recurrence, 1 patient survived with lung metastasis within 5 months, and 1 patient died of unrelated cause. There was no significant difference between the preoperative and postoperative estimated creatinine clearance rate by using the MDRD equation. CONCLUSIONS: Tumor exposure and cold ischemia were attempted in a partial resection of the kidney by VAMS with a LapSac(R). This technique for partial nephrectomy by VAMS might be an effective, safe modality.

Keyword

Video-assisted surgery; Laparotomy; Nephrectomy

MeSH Terms

Carcinoma, Renal Cell
Cold Ischemia
Cold Temperature
Creatinine
Follow-Up Studies
Humans
Kidney
Laparotomy
Lung
Neoplasm Metastasis
Nephrectomy
Operative Time
Recurrence
Retrospective Studies
Video-Assisted Surgery
Creatinine

Figure

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  Fig. 1. Technique of renal tumor exposure and cold ischemia using the LapSacⓇ. After wrapping the kidney with the LapSacⓇ, Hem-o-Lock clipping was applied to the LapSacⓇ opening placed in the renal hilum. The LapSacⓇ was dissected in four parts, and an ice slush was placed in the LapSacⓇ. Tumor exposure was easily performed by using these four parts.

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