Laparoscopic Partial Nephrectomy for Reanl Tumor: Single Center Experience Comparing Clamping and No Clamping Techniques of the Renal Vasculature

Abstract

No AccessJournal of UrologyCLINICAL UROLOGY: Original Articles1 Feb 2003Laparoscopic Partial Nephrectomy for Reanl Tumor: Single Center Experience Comparing Clamping and No Clamping Techniques of the Renal Vasculature B. GUILLONNEAU, H. BERMÚDEZ, S. GHOLAMI, H. EL FETTOUH, R. GUPTA, J. ADORNO ROSA, H. BAUMERT, X. CATHELINEAU, G. FROMONT, and G. VALLANCIEN B. GUILLONNEAUB. GUILLONNEAU , H. BERMÚDEZH. BERMÚDEZ , S. GHOLAMIS. GHOLAMI , H. EL FETTOUHH. EL FETTOUH , R. GUPTAR. GUPTA , J. ADORNO ROSAJ. ADORNO ROSA , H. BAUMERTH. BAUMERT , X. CATHELINEAUX. CATHELINEAU , G. FROMONTG. FROMONT , and G. VALLANCIENG. VALLANCIEN View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)63939-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We performed a nonrandomized retrospective comparison of 2 techniques for laparoscopic partial nephrectomy, that is without and with clamping the renal vessels. Materials and Methods: Between December 1997 and February 2002, 28 consecutive patients underwent transperitoneal laparoscopic partial nephrectomy for renal tumor. In group 1 (12 patients) partial nephrectomy was performed with ultrasonic shears and bipolar cautery without clamping the renal vessels, while in group 2 (16 patients) the renal pedicle was clamped before tumor excision. In group 2 patients intracorporeal kidney cooling was achieved by a ureteral catheter connected to 4C solution. Intracorporeal freehand suturing techniques were used to close the collecting system when opened and approximate the renal parenchyma. Results: All procedures were successfully completed laparoscopically. Mean renal ischemia time ± SD was 27.3 ± 7 minutes (range 15 to 47) in group 2 patients. Mean laparoscopic operating time was 179.1 ± 86 minutes (range 90 to 390) in group 1 compared with 121.5 ± 37 minutes (range 60 to 210) in group 2 (p = 0.004). Mean intraoperative blood loss was significantly higher in group 1 than in group 2 (708.3 ± 569 versus 270.3 ± 281 ml., p = 0.014). Three patients in group 1 and 2 in group 2 required blood transfusions. Immediately postoperatively mean creatinine was 1.26 ± 0.36 and 1.45 ± 0.61 mg./dl. in groups 1 and 2, respectively (p = 0.075). Surgical margins were negative in all specimens. Pathological examination revealed renal cell cancer in 18 cases (stages pT1 in 17 and pT3a in 1), oncocytoma in 4, angiomyolipoma in 5 and renal adenoma in 1. Conclusions: Laparoscopic partial nephrectomy represents a feasible option for patients with small renal masses. Clamping the renal vessels during tumor resection and suturing the kidney mimics the open technique and seems to be associated with less blood loss and shorter laparoscopic operative time. References 1 : Laparoscopic nephrectomy: initial case report. J Urol1991; 146: 278. Link, Google Scholar 2 : Complications of laparoscopic nephrectomy in 185 patients: a multi-institutional review. J Urol1995; 154: 479. Link, Google Scholar 3 : Laparoscopic radical nephrectomy: cancer control for renal cell carcinoma. J Urol2001; 166: 2095. Link, Google Scholar 4 : Nephron sparing surgery for localized renal cell carcinoma: impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol1999; 162: 1930. Link, Google Scholar 5 : Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year followup. J Urol2000; 163: 442. Link, Google Scholar 6 : Laparoscopic partial nephrectomy in the pig model. J Urol1993; 149: 1633. Link, Google Scholar 7 : Laparoscopic partial nephrectomy. The European experience. Urol Clin North Am2000; 27: 721. Google Scholar 8 : Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol2002; 167: 469. Link, Google Scholar 9 : Laparoscopic partial nephrectomy and wedge resection for the treatment of renal malignacy. J Endourol2001; 15: 369. Google Scholar 10 : Laparoscopic partial nep