Korean J Urol.  2006 Oct;47(10):1052-1058. 10.4111/kju.2006.47.10.1052.

Laparoscopic Nephron Sparing Surgery for Small Renal Cell Carcinoma less than 4cm

• Lee YS
• Lee SH
• Han WK
• Lee YH
• Yang SC
• Rha KH

• KMID: 2139804
• DOI: http://doi.org/10.4111/kju.2006.47.10.1052

Abstract

PURPOSE: Laparoscopic nephron sparing surgery has emerged as a feasible treatment option for patients with a small, exophytic renal mass. We evaluated and report our experience with laparoscopic nephron sparing surgery.
MATERIALS AND METHODS
Between December 2004 and October 2005, laparoscopic nephron sparing surgeries were performed for 11 exophytic renal masses less than 4cm. The mean mass size was 2.5cm (range: 1.7-3.5). The operative parameters, including the operative time, the estimated blood loss, the warm ischemic time and the postoperative hospital stay were evaluated. In addition, the oncological parameters such as the resection margin status and tumor recurrence were evaluated.
RESULTS
All procedures were completed laparoscopically and patients had satisfactory outcomes with objective cure follow up imaging studies. There were no definitely intraoperative and postoperative complications. The mean operative time was 145.8 minutes (range: 60-195), and the mean warm ischemic time was 28.5 minutes (range: 20-38). The mean blood loss was 307.1ml (range: 100-800), and the postoperative hospital stay was 5.8 days (range: 3-10). No positive resection margin and tumor recurrence were seen during follow-up periods (mean follow up: 6 months).
CONCLUSIONS
Laparoscopic nephron sparing surgery can be a safe and effective treatment for an exophytic renal mass less than 4cm. It could be considered as a primary procedure in selected cases to preserve the renal function.

Keyword

Laparoscopy; Renal cell carcinoma; Nephron

MeSH Terms

Carcinoma, Renal Cell*
Follow-Up Studies
Humans
Laparoscopy
Length of Stay
Nephrons*
Operative Time
Postoperative Complications
Recurrence
Warm Ischemia

Figure

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  Fig. 1 Port placement. Left sided procedure (A) and right sided procedure (B).

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  Fig. 2 Dissected renal artery and vein.

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  Fig. 3 Flexible laparoscopic ultrasound probe searching for the renal mass.

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  Fig. 4 Renal hilar vessels clamped by a laparoscopic Satinsky instrument.

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  Fig. 5 Renal parenchymal suture with using of surgical bolster.

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