Abstract

Objective: Laparoscopic partial nephrectomy has become an effective alternative for small renal tumors. In this study, we present our 20 retroperitoneal laparoscopic partial nephrectomy (LPN) cases.

Materials and methods: Retroperitoneal LPN was performed in 20 patients with renal tumor between December 2006 and June 2009. After retroperitoneal access and balloon dilation in lumbotomy position, the procedure was performed through the trocars located on the middle, anterior, and posterior axillary lines. Renal pedicle was reached by following psoas muscle. Renal artery was occluded by locking with a vascular strip. The tumor tissue was identified, and resected by electrocautery and scissors. Renal artery was not locked with the vascular strip in one case, and tumor was resected with harmonic scalpel. After placement of a surgicel, the parenchymal repair was accomplished with 2/0 vicryl suture.

Results: Mean age was 61 (range 52-74) years and tumor size was 3.1 (range 1.8-4.1) cm. Mean duration of warm ischemia and operation were 29 (range 22-36) min and 185 (range 148-234) min, respectively. The collecting system was opened in two patients. The collecting system repair was accomplished with 3/0 vicryl suture. Mean estimated blood loss during operation was 204 (range 165-280) mL. The drain was removed on 2nd (1-8) day postoperatively. Mean hospital stay was 4 (range 3-9) days. Pathological examination has revealed renal cell carcinoma in 19 cases (13 with clear cell, 5 with papillary cell, 1 with chromophobe cell) and angiomyolipoma in 1 case. The surgical margin was negative in all cases. At a median follow-up of 11 months (range 2-30), we did not observe local recurrence or distant metastasis in any patients.

Conclusion: LPN is accepted as a less invasive method in comparison with other therapeutic alternatives in treatment of renal tumors. It can be easily performed by experienced surgeons on patients with well-defined indications.