[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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Autor principal:	Ryohei Hattori
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2018
Materias:	Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/841c77d67e994568b8d675c046888ffd
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spelling	oai:doaj.org-article:841c77d67e994568b8d675c046888ffd2021-12-02T09:51:23Z[88] Laparoscopic partial nephrectomy for posterior hilar tumours: Technique and clinical outcomes2090-598X10.1016/j.aju.2018.10.042https://doaj.org/article/841c77d67e994568b8d675c046888ffd2018-11-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2090598X18301360https://doaj.org/toc/2090-598XObjective: 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.Ryohei HattoriTaylor & Francis GrouparticleDiseases of the genitourinary system. UrologyRC870-923ENArab Journal of Urology, Vol 16, Iss , Pp S41- (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Diseases of the genitourinary system. Urology RC870-923 Ryohei Hattori [88] Laparoscopic partial nephrectomy for posterior hilar tumours: Technique and clinical outcomes
description	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.
format	article
author	Ryohei Hattori
author_facet	Ryohei Hattori
author_sort	Ryohei Hattori
title	[88] Laparoscopic partial nephrectomy for posterior hilar tumours: Technique and clinical outcomes
title_short	[88] Laparoscopic partial nephrectomy for posterior hilar tumours: Technique and clinical outcomes
title_full	[88] Laparoscopic partial nephrectomy for posterior hilar tumours: Technique and clinical outcomes
title_fullStr	[88] Laparoscopic partial nephrectomy for posterior hilar tumours: Technique and clinical outcomes
title_full_unstemmed	[88] Laparoscopic partial nephrectomy for posterior hilar tumours: Technique and clinical outcomes
title_sort	[88] laparoscopic partial nephrectomy for posterior hilar tumours: technique and clinical outcomes
publisher	Taylor & Francis Group
publishDate	2018
url	https://doaj.org/article/841c77d67e994568b8d675c046888ffd
work_keys_str_mv	AT ryoheihattori 88laparoscopicpartialnephrectomyforposteriorhilartumourstechniqueandclinicaloutcomes
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[88] Laparoscopic partial nephrectomy for posterior hilar tumours: Technique and clinical outcomes

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