Experimental study and clinical applicatio 1 of transperitoneal laparoscopic nephron-sparing surgery

Objective To evaluate the feasibility and clinical effect of laparoscopic nephron-sparing surgery ( LNSS) in the treatment of small reral tumors. Methods On the basis of successful performance of laparoscopic partial nephrectomy in 2 pig models, we accomplished 8 cases of transperitoneal LNSS (tumor enucleation in 3 and partial nephrectomy in (?)) from November 2002 to March 2004. Of the 8 patients (4 males and 4 females with a mean age of 43 ears) ,5 had renal cell carcinoma and 3 had hamartoma. The mean tumor diameter was 2. 6cm (range,2.0-3. 8cm). Three tumors were located at the left and 5 at the right kidney. Our laparoscopic technique involved utilizing a plastic cable tie to achieve local parenchymal compression and ischemia, and transient clamping of the renal artery. Hemostasis was achieved with combined use of electrocautery,ultrasonic scalpel,gelatin sponges,fibrin glue and free hand intracorporeal laparoscopic suturing and knot tying. Results All procedures were successfully completed without conversion to open surgery. The mean operative time was 65 min (range, 130 -235 min) and mean blood loss was 240 ml ( range,80 -600 ml). The mean local paienchymal ischemia time using cable tie compression was 18 min ( range,0 - 30 min). The mean renal artery clamping time was 14 min ( range,0 - 20 min). All patients with renal cell carcinoma had negative surgical margins. The hospital stay averaged 7 d (range, 5 -9 d). Major complications occurred in 2 patients,i(?)cluding intraoperative splitting of the tumor in 1 and postoperative gastric ulcer in 1. During a mean follow - up of 10 months (range,3 - 19 months) no patient had renal functional damage and recurrence or metastasis. Conclusions LNSS is a feasible and safe alternative for strictly selected patients with small renal tumor. Using cable tie to compress renal parenchyma makes it possible to reduce the time of renal artery clamping and thus to protect the kidney from ischemic damage. This method also provides sufficient surgical manipulating time. Hemostasis can be achieved by combined use of several methods or materials and the skilled intracorporeal suturing and knot tying is the key to successful LNSS.