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Gasless laparoendoscopic single‐port clampless sutureless partial nephrectomy for peripheral renal tumors: Perioperative outcomes
Author(s) -
Kihara Kazunori,
Koga Fumitaka,
Fujii Yasuhisa,
Masuda Hitoshi,
Tatokoro Manabu,
Yokoyama Minato,
Matsuoka Yoh,
Numao Noboru,
Ishioka Junichiro,
Saito Kazutaka
Publication year - 2015
Publication title -
international journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.172
H-Index - 67
eISSN - 1442-2042
pISSN - 0919-8172
DOI - 10.1111/iju.12687
Subject(s) - medicine , nephrectomy , renal cell carcinoma , surgery , perioperative , kidney cancer , renal function , blood loss , port (circuit theory) , hemostasis , kidney , urology , electrical engineering , engineering
Objectives To describe the technical aspects of gasless laparoendoscopic single‐port clampless sutureless partial nephrectomy for peripheral renal tumors, and to evaluate its outcomes, including surgical, pathological, and short‐term oncological and functional outcomes. Methods Between January 2010 and June 2013, 103 patients with peripheral renal tumors suggestive of renal cell carcinoma underwent gasless laparoendoscopic single‐port partial nephrectomy. In all cases, an attempt was made to accomplish partial nephrectomy without vascular clamping using ultrasonic coagulating and bipolar sealing devices. Hemostasis was achieved by coagulation and hemostatic agents without reconstructing the renal parenchyma. Results Of the 103 patients, gasless laparoendoscopic single‐port partial nephrectomy was accomplished without vascular clamping and parenchymal suture in all but two patients (98%). Median operative time and blood loss were 191 min and 244 mL, respectively. One patient (1%) received allogeneic blood transfusion. The median postoperative time to full recovery was 3 days. Three major complications (3%, all grade 3 urinary leakage) were observed. Of 92 renal cell carcinoma patients, four (4%) had positive surgical margins, most of which underwent thermal degeneration histologically. In 91 non‐metastatic renal cell carcinoma patients, 3‐year local recurrence‐free, progression‐free, cancer‐specific and overall survival rates were 100%, 99%, 100%, and 100%, respectively (mean follow‐up period, 21 months). In the 103 patients, the median percent decrease in estimated glomerular filtration rate 3 months after partial nephrectomy was 2.4%. Conclusions Gasless laparoendoscopic single‐port clampless sutureless partial nephrectomy can be accomplished in almost all cases of peripheral renal tumors. This surgery is technically feasible and safe, yielding acceptable short‐term oncological outcomes and maximal preservation of renal function.