V1086: Zero ischemia laparoscopic partial nephrectomy. Preliminary experience.
VideoIntroduction and Objectives
Laparoscopic partial nephrectomy (LPN) remains a technically challenging procedure that requires advanced laparoscopic skill. Bleeding is one of the most fearful complication of LPN. Warm ischemia time is a mainstay issue that could impact on renal function. Video shows two cases of “zero ischemia” laparoscopic partial nephrectomy
In the first case a transperitoneal approach is performed; medialization of colon and isolation of renal vessels. Renal tumour is identified. A controlled hypotension is realized to reduce bleeding without clamping. The renal lesion is excised using cold endoshears. Parenchyma is repaired with Vicryl™ sutures arrested with Hem-O-lok™ clips. Application of Floseal™ covered by Surgicell™ precedes peritoneum closure. In the second case resection of tumour is realized without previous vessels isolation. Renal parenchyma is repaired with Vicryl™ sutures. We proceed with application of Floseal™ covered by Surgicell™.
10 patients underwent laparoscopic partial nephrectomy (4 right, 6 left) without clamping for renal tumour (8 patients) and for renal lithiasis (2 patients). Mean age of the patients was 50.9 years (±18.7) . Mean tumour size was 3.7 cm (±1.5). Operative time was 175 (±50.4) minutes; blood loss was 435 (±280) ml. Two patients required blood transfusion. Mean hospitalization was 7.3 (2.8) days. In one patient postoperative urine leakage required placing of ureteral stent. Histological evaluation revealed a Renal Cell Carcinoma in 5 patients, an oncocytoma in 2 patient, an angiomyolipoma in 1 patient. All surgical margin were negative for cancer.
Zero-ischemia laparoscopic partial nephrectomy without hilar clamping is feasible and safe. Eliminating global renal ischemia now appears achievable. It allows both preservation from ischemic renal damage and an excellent control of bleeding