V5-09 ROBOT ASSISTED LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR A T2B LESION: TECHNIQUE AND OUTCOMES

introduced a novel non-tissue suturing laparoscopic partial nephrectomy (NTS-LPN) and compared clinical outcomes with conventional laparoscopic partial nephrectomy (C-LPN) in our institution. METHODS: A hundred-eighty five patients who underwent partial nephrectomy since 2004 were divided between NTS-LPN group (NTS) (n1⁄498) and C-LPN group (C) (n1⁄487). The surgical maneuver of NTS differs with C after excising tumor with renal artery clamping. The resected surface was simply coagulated using a soft-coagulation system (a VIO system and an IO electrode) without parenchyma suturing. After declamping, a TachoSil is attached on coagulated surface. Perioperative data including the parenchymal volume of postoperative renal ischemic volume (PRIV) and the change of residual renal volume (RRV) calculated by 3D-CT volumetry, postoperative kidney function and adverse events were compared between 2 groups. RESULTS: Mean operative time and renal ischemic time in NTS (146 34.0min/15.6 7.45min) were dramatically shortened as compared to those in C (236 77.8min/54.8 27.4min). Mean operative blood loss was similar between NTS (43.3 61.5ml) and C (65.9 91.9ml). Renal parenchymal damage as shown PRIV was significantly less in NTS group than that in C at the point of postoperative 3, 6, 12 months (NTS: 4.26 2.29ml, 2.37 1.02ml, 1.67 0.55ml / C: 19.4 5.49ml, 15.9 8.20ml, 13.1 6.00ml). Renal atrophy as shown RRV postoperative 3, 6, 12 months was also significantly less in NTS than that in C (p<0.01). No positive surgical margin was observed in NTS, but only one case in C. Serum creatinine values of each point (1/3/6/12 months) were comparable in both groups. According to Clavien-Dindo classification, major complications of IIIa (postoperative bleeding, minor urinary leakage and peri-renal abscess) were observed in C, whereas 2 cases of minor urinary leakage in NTS. In addition, 6 cases of pseudo aneurysm were only observed in C. CONCLUSIONS: A novel technique of NTS-LPS could spare operative and ischemic time and nephron loss as well without increasing invasiveness compared with conventional tissue-suturing partial nephrectomy.