V5-05: 3D LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR COMPLEX RENAL MASS
VideoIntroductions and Objectives
The Current surgical recommendation for clinical T1a renal masses is partial nephrectomy. In T1b disease an increasing trend exists for the same surgical treatment when possible. Laparoscopic partial nephrectomy (LPN) has emerged as an effective treatment option in select patients with a solid renal tumor, scant data are available on cystic renal tumors. As experience increased, the use of LPN was expanded to technically challenging tumours. Also, hemostatic renorrhaphy in these tumours create additional challenges
Case 1:A 42 yr old female presented with intermittent dull right flank pain for 1year duration. She was on usg follow up for simple cortical cyst elsewhere. Evaluation with CT IVU revealed a 8 X 9 cm complex cystic mass with enhancement in the right kidney. The patient underwent 3 D laparoscopic partial nephrectomy. Case2: A 43 year old male presented with dull left flank pain for the past 1 month duration. USG and MRI revealed a 4 X 5cm enhancing midpole mass lesion in the posterior aspect of left kidney. 3D Lap was attempted considering the difficult location of the tumour. The Technical steps included en bloc hilar clamping and cold excision of tumor. The remnant renal parenchyma was sutured with a single layer of No 2-0 vicryl suture in a continuous fashion. Tension in suture line was maintained by sequential application of hem-o-lok clips. No separate tissue sealant or surgical bolster was employed, no separate calicorrhaphy was conducted. Operative and postoperative events were recorded in detail.
We have done a total of 102 lap partial nephrectomies with 12 lap heminephrectomies .The mean tumor size was 5.3 cm, the mean blood loss was 225 cc and mean warm ischemia time was 20.4 min. Orals were started by day 1. Drain removal was on the second day and the duration of hospital stay was 3 days. There were no specific intraoperative or postoperative complications. The histopathology for case 1 was Papillary cell carcinoma and for case 2 was consistent with renal cell carcinoma and the margins were free of tumour. There was no recurrence on follow up.
3D Laparoscopic Partial nephrectomy for complex renal mass may be successfully attempted without separate calicorrhaphy or usage of tissue sealants or surgicel bolster with no additional procedural morbidity and acceptable long term oncological and functional outcome.