Laparoscopic partial nephrectomy: contemporary technique and outcomes

Abstract

Objectives: Laparoscopic partial nephrectomy has emerged as a viable alternative to open partial nephrectomy while minimizing patient morbidity. In this article and accompanying video we describe our current technique of LPN and review our outcomes in specific patient sub-sets.

Methods: Since September 1999 more than 500 laparoscopic partial nephrectomies have been performed by the senior author. Data were collected prospectively. All patients underwent a three-dimensional CT scan prior to the operation. Our established technique involves preoperative ureteral catheterization, laparoscopic renal ultrasonography to delineate the tumor, en bloc clamping of the renal hilar vascular pedicle, tumor excision with cold endoshears, pelvicaliceal suture repair and parenchymal closure over Surgicel bolsters with biologic hemostatic agent. Renal hypothermia was achieved laparoscopically with ice slush in selected cases with anticipated long warm ischemia time.

Results: Mean tumor size was 2.9 cm (1-10.3 cm), 31% of the tumors were greater than 3 cm, 5% occurred in a solitary kidney, and tumor location was central in 40% and hilar in 6% of patients. Transperitoneal approach was employed in 65% of the cases. Mean warm ischemia time was 32 min. Intraoperative complications occurred in 5.5%. Pathology confirmed renal cell carcinoma in 75% of the tumors. In the initial 100 patients with a 3 years minimum follow-up, overall survival was 86% and cancer-specific survival was 100%.

Conclusions: Laparoscopic partial nephrectomy is a technically challenging procedure. Adequate prior experience with laparoscopy is necessary. Long-term functional and oncological outcomes are being confirmed currently.