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

Giuseppe Simone, Rocco Papalia, Salvatore Guaglianone, Michele Gallucci

Research output: Contribution to journalArticle

Abstract

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 ≤4cm, predominant exophytic growth and intraparenchymal depth ≤1.5cm, with a minimum distance of 5mm from the urinary collecting system. • Hilar vessels were not isolated, tumour dissection was performed with 10-mm LigaSureTM (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.

Original languageEnglish
JournalBJU International
DOIs
Publication statusAccepted/In press - 1800

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Keywords

  • Ischaemia
  • Kidney neoplasms
  • Kidney tumour
  • Laparoscopy
  • Partial nephrectomy
  • Unclamped

ASJC Scopus subject areas

  • Medicine(all)
  • Immunology and Microbiology(all)
  • Organic Chemistry
  • Business, Management and Accounting(all)
  • Political Science and International Relations
  • Urology

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