V5-09: 3-mm Laparoscopic Off-Clamp Renal Tumorectomy using Hydrodissection
VideoIntroductions and Objectives
European guidelines recommend Nephron Sparing Surgery in pT1 tumours Surgery has evolved towards minimizing trauma to the abdominal wall._x000D_ Minimizing warm ischemia time is important to reduce kidney damage._x000D_ In this case we combine the use of 3-mm laparoscopic instruments which reduces the incision site, while maintaining safety and good clinical outcomes and hydrodissection through a saline jet that helps performing partial nephrectomy without clamping.
We present the surgery of a 71-year-old patient, with no relevant medical history, diagnosed by CT scan with a 44 mm renal tumor in the posterior aspect of the inferior third of the left kidney. Three 3mm trocars were inserted in a diamond shape position, including one for the 3mm laparoscope. To develop the retroperitoneal space and in order to maintain the pneumoperitoneum and a good access for Hem-o-locks a 11mm forth trocar was placed. Hydrodissection was used to identify the tumorectomy plane and allowed a selective control of the tumoral vessels._x000D_ We have analyzed our Retroperitoneal Laparoscopic Partial Nephrectomies (RLPN) performed in the last 3 years by a single surgeon. We analyzed retrospectively the patient’s demographics, tumor characteristics, surgical time, blood loss, warm ischemia time, complications, and renal function. We analyzed the results as whole and specifically the 3 mm cases.
The surgical time was 150 minutes with a blood lose of 300 ml. The patient presented an uneventful recovery and was discharged at day 3. The pathologist report was of an Oncocytoma._x000D_ Although, the reduced rigidity of the 3mm scissors made the dissection more difficult, the 3 mm instruments were considered to work appropriately for this surgery and no additional trocar was deemed necessary._x000D_ In the last 3 years, we have performed 47 RLPN. The male/female ratio was 4.87, the mean age was 61.8 years, and mean body mass index was 27,8. The mean tumor size, according to CT scans was 35.05 mm. The mean surgical time was 173 minutes, with a mean blood loss volume of 419 ml. From these, the ones using 3mm presented similar demographic characteristics, a bleeding volume of 292.2, a mean surgical time of 117 minutes, and a similar hospital stay. Hydrodissection was used in 2 cases.
Retroperitoneal Laparoscopic Partial Nephrectomy is a good approach for the treatment of posterior small (