Abstract
Introduction:
Partial nephrectomy (PN) is the treatment of choice in localized renal cell cancer. It depends largely on the anatomy and location of the tumor, as well as the surgeon's experience. 1 –6 We present an educational video to offer different tips and tricks for a safe laparoscopic surgical technique, which shortens the operating time and the warm ischemia by reducing the intra- and postoperative bleeding, without conditioning the oncologic results.
Materials and Methods:
A retrospective study of a series of 77 patients with localized kidney cancer underwent laparoscopic partial nephrectomy (LPN) at our center (July 2011–August 2018). Descriptive statistics, Mann–Whitney U test, and chi-square test were used to establish significant differences between the pooled years 2011–2012 (n = 12) vs 2017–2018 (n = 12).
Results:
Our proposed improvements are (1) renal suspension assisted by clip, (2) control of vessel bleeding with bipolar plus a selective second-generation polymer clip, and (3) optimization of renorraphy with barbed suture in a specific pattern of hemostatic plus selective clip. Median (range) radiologic size of the tumor was 3.7 cm (1.3–7.3), with no significant differences between the pooled 2011–2012 vs 2017–2018 years: 3.85 cm (1.6–7) vs 4 cm (1.3–5.8). The operating time was 180 minutes (80–340), warm ischemia time was 22 minutes (12–32), and the intraoperative blood loss was 180 mL (30–500). We found an improvement of our learning curve between the pooled 2011–2012 vs 2017–2018 years, although differences were nonsignificant for operating time: 180 minutes (120–240) vs 160 minutes (80–210), warm ischemia time: 25 minutes (11–28) vs 23 minutes (19–27), and intraoperative blood loss: 220 mL (30–500) vs 160 mL (50–400). However, there was a significant decrease in patients with positive surgical margins [n (%)] between the pooled 2011–2012 vs 2017–2018: positive 7 (58.3%)/negative 5 (41.7%) vs positive 2 (16.7%)/negative 10 (83.3%), (p = 0.0073).
Conclusions:
The implementation by our group of these particular modifications on LPN allowed us to acquire a technical improvement and to increase the effectiveness of this procedure, thus offering a functional advantage with low rate of complications.
No competing financial interests exist.
Runtime of video: 8 mins 2 secs
Patient Consent:
Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.
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