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• W2006334706 abstract "No AccessJournal of UrologyAdult Urology1 Oct 2008Tailoring Technique of Laparoscopic Partial Nephrectomy to Tumor Characteristics Alon Z. Weizer, Scott M. Gilbert, William W. Roberts, Brent K. Hollenbeck, and J. Stuart Wolf Alon Z. WeizerAlon Z. Weizer Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Scott M. GilbertScott M. Gilbert Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , William W. RobertsWilliam W. Roberts Division of Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , Brent K. HollenbeckBrent K. Hollenbeck Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author , and J. Stuart WolfJ. Stuart Wolf Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan Financial interest and/or other relationship with Terumo and Omeros. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2008.06.066AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We use a tailored approach to laparoscopic partial nephrectomy based on tumor depth of penetration and proximity to the renal sinus. We evaluated differences in perioperative outcomes to determine the value of this paradigm. Materials and Methods: The surgical approach to hilar clamping and tumor bed management during laparoscopic partial nephrectomy included no clamp or suture, clamp with no suture, and clamp and suture. The end points assessed retrospectively were differences in perioperative, pathological and complication outcomes among these groups. Results: Our surgical paradigm was used in 174 patients, including no clamp or suture in 36, clamp with no suture in 25, and clamp and suture in 113. Compared to the other patients those with a clamp and suture procedure were older with larger and deeper tumors that were closer to the renal sinus-collecting system and more likely to be malignant. Operative time was shortest in the no clamp or suture group and in the 2 clamp groups warm ischemia and operative times were shorter than in the no suture group. Estimated blood loss, hospital stay, surgical margins, complications and recurrences did not differ among the groups. A creatinine increase of 0.3 mg/dl or greater was seen in 33 patients (19%) following surgery, which was attributable to conversion to nephrectomy in 4, contralateral nephrectomy or partial nephrectomy in 3 and underlying medical renal disease in 1. In the remaining 25 patients no other cause was apparent except renal hilar clamping and tumor resection. Conclusions: A tailored approach based on tumor location and proximity to the renal sinus-collecting system can limit operative and ischemia times, and technically simplify the procedure without adversely impacting morbidity, convalescence and oncological outcomes. References 1 : Randomized controlled trial of hand-assisted laparoscopic versus open surgical live donor nephrectomy. Transplantation2001; 72: 284. Google Scholar 2 : Long-term survival analysis after laparoscopic radical nephrectomy. J Urol2005; 174: 1222. Link, Google Scholar 3 : Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol2003; 170: 64. Link, Google Scholar 4 : Laparoscopic nephron-sparing surgery for a renal mass: 1-year minimum follow-up. J Endourol2004; 18: 783. Google Scholar 5 : Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol2007; 178: 41. Link, Google Scholar 6 : Acute integrity of closure for partial nephrectomy: comparison of 7 agents in a hypertensive porcine model. J Urol2006; 175: 2307. Link, Google Scholar 7 : Surgery of the kidney. In: Campbell's Urology. Edited by . Philadelphia: WB Saunders2002: 3571. vol 4. Google Scholar 8 : Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion. J Urol2004; 171: 68. Link, Google Scholar 9 : Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience. J Urol2003; 170: 52. Link, Google Scholar 10 : Transureteral saline perfusion to obtain renal hypothermia: potential application in laparoscopic partial nephrectomy. JSLS2004; 8: 217. Google Scholar 11 : Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol2006; 7: 735. Google Scholar 12 : Comparison of laparoscopic radical and partial nephrectomy: effects on long-term serum creatinine. Urology2007; 69: 1035. Google Scholar 13 : Fibrin glue versus sutured bolster: lessons learned during 100 laparoscopic partial nephrectomies. J Urol2005; 174: 47. Link, Google Scholar 14 : Laparoscopic partial nephrectomy: technique, oncologic efficacy, and safety. Curr Urol Rep2005; 6: 19. Google Scholar 15 : Malignant hypertension due to renal artery stenosis after open partial nephrectomy in a solitary kidney. Urology2007; 69: 385 e5. Google Scholar 16 : Laparoscopic nephron-sparing surgery for the small exophytic renal mass. JSLS2005; 9: 199. Google Scholar 17 : Laparoscopic partial nephrectomy: use of the TissueLink hemostatic dissection device. J Endourol2005; 19: 446. Google Scholar 18 : Mayo Clinic Scottsdale experience with laparoscopic nephron sparing surgery for renal tumors. J Urol2003; 169: 2059. Link, Google Scholar 19 : Hemostatic laparoscopic partial nephrectomy assisted by a water-cooled, high-density, monopolar device without renal vascular control. Urology2003; 61: 906. Google Scholar 20 : Laparoscopic partial nephrectomy of solid renal masses without hilar clamping using a monopolar radio frequency device. J Urol2004; 171: 1054. Link, Google Scholar © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byEllison J, Montgomery J, Wolf J, Hafez K, Miller D and Weizer A (2012) A Matched Comparison of Perioperative Outcomes of a Single Laparoscopic Surgeon Versus a Multisurgeon Robot-Assisted Cohort for Partial NephrectomyJournal of Urology, VOL. 188, NO. 1, (45-50), Online publication date: 1-Jul-2012.Papalia R, Simone G, Ferriero M, Costantini M, Guaglianone S, Forastiere E and Gallucci M (2012) Laparoscopic and Robotic Partial Nephrectomy With Controlled Hypotensive Anesthesia to Avoid Hilar Clamping: Feasibility, Safety and Perioperative Functional OutcomesJournal of Urology, VOL. 187, NO. 4, (1190-1194), Online publication date: 1-Apr-2012.Kutikov A and Uzzo R (2009) The R.E.N.A.L. Nephrometry Score: A Comprehensive Standardized System for Quantitating Renal Tumor Size, Location and DepthJournal of Urology, VOL. 182, NO. 3, (844-853), Online publication date: 1-Sep-2009. Volume 180Issue 4October 2008Page: 1273-1278Supplementary Materials Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordslaparoscopysuturesnephrectomykidney neoplasmssurgical instrumentsMetricsAuthor Information Alon Z. Weizer Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Scott M. Gilbert Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author William W. Roberts Division of Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author Brent K. Hollenbeck Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan More articles by this author J. Stuart Wolf Division of Urologic Oncology, Department of Urology, University of Michigan, Ann Arbor, Michigan Division of Minimally Invasive Surgery, Department of Urology, University of Michigan, Ann Arbor, Michigan Financial interest and/or other relationship with Terumo and Omeros. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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