Abstract
Background:
Laparoscopic partial nephrectomy (LPN) utilizes warm ischemia to temporally reduce the renal blood perfusion to perform a precise tumoral excision and kidney reconstruction. However, prolonged ischemia time is followed by functional damage that could be irreversible. In the past years, some researches try to develop off-clamping techniques to reduce the ischemic damage to achieve better functional preservation. There are few series reporting off-clamp LPN in hilar, central, or big tumors. The aim of this video is to demonstrate our surgical technique in this complex situation.
Methods:
We selected 20 patients with high-complexity renal tumors, according to the RENAL score, normal renal function, and normal contralateral kidney. They were subjected to our technique that includes spiral harmonic scalpel excavation with minimal margins and increased pneumoperitoneum in the resection of the most deep portion of the tumor. We evaluated age, gender, BMI, and RENAL score, and reported the demographic, perioperative, preliminary oncologic, and functional outcomes with minimum follow-up of 1 year.
Results:
All 20 cases were subjected effectively to our off-clamping technique. Mean operative time was 168 ± 20.99 minutes. Mean blood loss was 423 ± 63 mL. One patient (5%) needed blood transfusion. One patient had a postoperative retroperitoneal urinoma that was drained and stented. One patient had Furhman 2 clear cell carcinoma that had a positive focal margin, who was without evidence of recurrence in 5 years of follow-up. No patient developed renal insufficiency or significant long-term reduction in renal function.
Conclusion:
Off-clamp LPN is feasible and safe in complex renal tumors, presenting excellent oncologic and functional outcomes. In our opinion, high-complex cases demand special surgeon skills and must to be performed only by experienced laparoscopic surgeons. Further studies are needed to determine whether renal function outcomes are similar to that seen by the open or robotic approach.
No competing financial interests exist.
Runtime of video: 7 mins 50 secs
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