[88] Laparoscopic partial nephrectomy for posterior hilar tumours: Technique and clinical outcomes
Objective: To demonstrate our technique and clinical outcomes of laparoscopic partial nephrectomy (LPN) for posterior hilar tumours. Posterior renal hilar tumours, due to their anatomical location, pose some technical challenges for LPN. Methods: In all, 10 patients with posterior renal hilar tumour...
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| Formato: | article |
| Lenguaje: | EN |
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Taylor & Francis Group
2018
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| Acceso en línea: | https://doaj.org/article/841c77d67e994568b8d675c046888ffd |
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| Sumario: | Objective: To demonstrate our technique and clinical outcomes of laparoscopic partial nephrectomy (LPN) for posterior hilar tumours. Posterior renal hilar tumours, due to their anatomical location, pose some technical challenges for LPN. Methods: In all, 10 patients with posterior renal hilar tumours received LPN at our institution from November 2015 to May 2018. Our surgical technique involves a transperitoneal approach, full kidney mobilisation to flip the kidney medially for access to its posterior aspect, and the following procedures to the maximum extent possible before artery clamping: intrasinusal dissection upon the intrarenal collecting system and segmental vessels, ligation and division of the vessels supplying the tumour, parenchymal incision through the hilum, and circumferential cortical incision around the tumour with electrocautery. After main or segmental artery clamping, the tumour excision is completed and renorrhaphy is performed. Results: The median (range) tumour size was 32 (23–55) mm. The R.E.N.A.L. (Radius; Exophytic/Endophytic; Nearness; Anterior/Posterior; Location) nephrometry score was 8 in four patients, 9 in five patients, and 10 in one patient. Five patients underwent surgeries with main renal artery clamping, and two underwent surgeries with segmental artery clamping. The latest three patients underwent surgeries without clamping. The median (range) warm ischaemia time (WIT) was 18 (10–25) min and estimated blood loss was 150 (0–275) mL. Histopathology confirmed renal cell carcinoma with negative margins in all patients. Postoperative urine leakage was detected in two patients. The median change in estimated glomerular filtration rate at 1, 3 and 6 months postoperatively were −11%, −9% and −8%, respectively. Conclusion: For posterior renal hilar tumours, the described technique is safe and allows a reduction in WIT and preservation of renal function. |
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