Purpose: This study aimed to document the surgical and oncologic results of nephron sparing of non-ischemic laparoscopic partial nephrectomy without the step of hilus controlling and even without dissecting to expose the main renal vascularity and directly focusing on mass removal.
Materials & Methods: The records of the patients who underwent our modified laparoscopic partial nephrectomy technique were evaluated retrospectively. The patients’ medical records, including tumor complexity calculated via R.E.N.A.L nephrometry scores, operation time, estimated blood loss, blood transfusions, hospital stay, pre- and postoperative serum creatinine levels, complications via the Clavien classification system, pathological status of surgical margin, and follow-up times, were documented.
Result: The data of 55 patients with 58 renal units were evaluated. Almost all tumors were in the low complex group (91%), with a mean size of 31.74 ± 7.38 mm (range: 12-46 mm). Mean operation time, estimated blood loss, and transfusion rates were 138.62 ± 38.45 minutes (range: 90-240 min), 242.24 ± 107.12 mL (range: 100-500 mL), and 19%, respectively. The hemoglobin level decreased by a mean of 2.05 ± 0.87 g/dL. Whereas the perioperative complications were Clavien grades I, II, and III (74%, 23%, and 3%, respectively), mean hospital stay and follow-up time were 4.05 ± 1.97 and 19.67 ± 13.57 (ranges: 2-10 days and 1-44 months), respectively.
Conclusion: Present un-controlled results pointed that tumor-focusing nephron-sparing non-ischemic partial laparoscopic nephrectomy may be preferable for small-sized, low-complex renal masses.
Kamachi K, Kojima K, Nishijima A, Takeshita M, Ando T, Kimura S. Small lymphocytic lymphoma presenting as bulky renal incidentaloma. Int J Hematol 2014; 100:107-8.
Gill IS, Kavoussi LR, Lane BN, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 2007; 178:41-6.
Aboumarzouk OM, Stein RJ, Eyraud R, et al. Robotic versus laparoscopic partial nephrectomy: a systematic review and meta-analysis. Eur Urol 2012; 62:1023-33.
Jain S, Gautam G. Robotics in urologic oncology. J Minim Access Surg 2015; 11:40-4.
Zehnder P, Eisenberg MS, Gill IS. Renal Surgery for Malignant Disease. Nephron-Sparing Surgery, In: Smith AD (ed): Smith’s Textbook of Endourology, New York: Wiley-Blackwell Publication, 2012, pp:1014-24.
Kavoussi LR, Schwartz MJ, Gill IS. Laparoscopic surgery of the kidney. In: Wein (ed): Campbell-Walsh Urology, Philadelphia: Saunders Elsevier Science, 2012,1628-82.
Forastiere E, Claroni C, Sofra M, et al. Evaluation of renal function under controlled hypotension in zero ischemia robotic assisted partial nephrectomy. Kidney Blood Press Res 2013; 38:181-5.
Hotston MR, Keeley FX. Laparoscopic partial nephrectomy without ischemia. Arch Esp Urol 2013; 66:146-51.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205-13.
Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol 2009; 182:844-53.
Kim KS, Choi SW, Kim JH, et al. Running-clip renorrhaphy reducing warm ischemic time during laparoscopic partial nephrectomy. J Laparoendosc Adv Surg Tech A. 2015; 25:50-4.
Capitanio U, Montorsi F. Renal cancer. Lancet 2016; 387:894-906.
Edge SB, Compton CC. The American Joint Committee on Cancer: The 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol. 2010; 17:1471-4.
Touma NJ, Matsumoto ED, Kapoor A. Laparoscopic partial nephrectomy: The Mc Master University experience. Can Urol Assoc J. 2012; 6:233-6.
Bazzi WM, Allaf ME, Berkowitz J, Atalah HN, Parekattil S, Derweesh IH. Multicenter experience with nonischemic multiport laparoscopic and laparoendoscopic single-site partial nephrectomy utilizing bipolar radiofrequency ablation coagulator. Diagn Ther Endosc 2011; 2011:636537.
Yuksel OH, Otunctemur A, Ozbek E, Uruc F, Verit A. Should oncological cases of upper urinary system be excluded at the beginning of the laparoscopic learning curve? Int Braz J Urol 2015; 41:707-13.
Acar Ö, Esen T, Musaoğlu A, Vural M. Do we need to clamp the renal hilum liberally during the initial phase of the learning curve of the robot assisted nephron-sparing surgery? Scientific World Journal 2014;498917.
Choi JE, You JH, Kim DK, Rha KH, Lee SH. Comparison of perioperative outcomes robotic between and laparoscopic partial nephrectomy: A Systematic review and meta-analysis. Eur Urol 2015; 67:891-901.
Aron M, Koenig P, Kaouk JH, Nguyen MM, Desai MM, Gill IS. Robotic and laparoscopic partial nephrectomy: a matched-pair comparison from a high-volume centre. BJU Int 2008; 102:86-92.
Yang CM, Chung HJ, Huang YH, Lin TP, Lin AT, Chen KK. Standardized analysis of laparoscopic and robotic assisted partial nephrectomy complications with Clavien classification. J Chin Med Assoc 2014; 7:637-41.
Masson-Lecomte A, Bensalah K, Seringe E, et al. A prospective comparison of surgical and pathological outcomes obtained after robot-assisted or pure laparoscopic partial nephrectomy in moderate to complex renal tumours: results from a French multicentre collaborative study. BJU Int 2013; 111:256-63.
Chaste D, Couapel JP, Fardoun T, et al. Robot-assisted partial nephrectomy versus laparoscopic partial nephrectomy: a single institution experience. Prog Urol 2013; 23:176–83.
Rezaeetalab GH, Karami H, Dadkhah F, Simforoosh N, Shakhssalim N. Laparoscopic Versus Open Partial Nephrectomy for Stage T1a of Renal Tumors. Urol J. 2016; 13:2903-7.
Zhang K, Xie WL. Determination of the Safe Surgical Margin for T1b Renal Cell Carcinoma. Urol J. 2017; 14:2961-7.
Leslie S, Goh AC, Gill IS. Partial nephrectomy--contemporary indications, techniques and outcomes. Nat Rev Urol 2013; 10:275-83.
Roushias S, Vasdev N, Ganai B, et al. Can the R.E.N.A.L Nephrometry Score Preoperatively Predict Postoperative Clinical Outcomes in Patients Undergoing Open and Laparoscopic Partial Nephrectomy? Curr Urol 2013; 7:90-7.
Nouralizadeh A, Simforoosh N, Tabibi A, Basiri A, et al. Laparoscopic partial nephrectomy for tumours >4 cm compared with smaller tumours: perioperative results. Int Urol Nephrol. 2011; 43:371-6.
Turna B, Aron M, Frota R, Desai MM, Kaouk J, Gill IS. Feasibility of laparoscopic partial nephrectomy after previous ipsilateral renal procedures. Urology 2008; 72:584-8.
Kawai N, Yasui T, Umemoto Y, et al. Laparoendoscopic single-site partial nephrectomy without hilar clamping using a microwave tissue coagulator. J Endourol 2014; 28:184-90.
Castillo OA, Rodriguez-Carlin A, Lopez-Fontana G, Aleman E. Robotic partial nephrectomy with selective parenchymal compression (Simon clamp). Actas Urol Esp 2013; 37:425-8.
Shao P, Tang L, Li P, et al. Application of a vasculature model and standardization of the renal hilar approach in laparoscopic partial nephrectomy for precise segmental artery clamping. Eur Urol 2013; 63:1072-81.
Papalia R, Simone G, Ferriero M, et al. Laparoscopic and robotic partial nephrectomy with controlled hypotensive anesthesia to avoid hilar clamping: feasibility, safety and perioperative functional outcomes. J Urol 2012; 187;1190-4.