'Zero ischaemia', sutureless laparoscopic partial nephrectomy for renal tumours with a low nephrometry score

OBJECTIVE: • To describe the technique and report the results of 'zero ischaemia', sutureless laparoscopic partial nephrectomy (LPN) for renal tumours with a low nephrometry score. PATIENTS AND METHODS: • Between August 2003 and January 2010, data from 101 consecutive patients who underwent 'zero ischaemia', sutureless LPN were collected in a prospectively maintained database. • Inclusion criteria were tumour size ≤ 4 cm, predominant exophytic growth and intraparenchymal depth ≤ 1.5 cm, with a minimum distance of 5 mm from the urinary collecting system. • Hilar vessels were not isolated, tumour dissection was performed with 10-mm LigaSure TM (Covidien, Boulder, CO, USA) and haemostasis was performed with coagulation and biological haemostatic agents without reconstructing the renal parenchyma. • Clinical, perioperative and follow-up data were collected prospectively, and modifications of functional outcome variables were analysed using the paired Wilcoxon test. RESULTS: • The median (range) tumour size was 2.4 (1.5-4) cm, and the median (range) intraparenchymal depth was 0.7 (0.4-1.4) cm. • Hilar clamping was not necessary in any patient, and suture was performed in four patients to ensure complete haemostasis. The median (range) operation duration was 60 (45-160) min, and median (range) intraoperative blood loss was 100 (20-240) mL. • Postoperative complications included fever (n = 4), low urinary output (n = 3) and haematoma, which was treated conservatively (n = 2). The median (range) hospital stay was 3 (2-5) days. The pathologist reported 30 benign tumours and renal cell carcinoma in 71 cases (pT1a in 69 patients, and pT1b in two patients). • At a median follow-up of 57 months, one patient underwent radical nephrectomy for ipsilateral recurrence. The 1-year median (range) decrease of split renal function at renal scintigraphy was 1 (0-5) %. CONCLUSIONS: • Zero ischaemia LPN is a reasonable approach to treating small and peripheral tumours, and a sutureless procedure is feasible in most cases. • This technique has a low complication rate and provides excellent functional outcome without impairing oncological results.