Laparoscopic partial nephrectomy for renal tumor: Nagoya experience.
OBJECTIVE
To clarify the indication for a vascular clamp during laparoscopic partial nephrectomy, the clinical results of 17 patients who underwent the procedure for small renal tumors were reviewed.


METHODS
Seventeen patients with renal tumors were enrolled in our laparoscopic partial nephrectomy program between October 1999 and November 2003. During laparoscopy, a vascular clamp was used to remove the tumor mass and suture the incised renal parenchyma and urinary collecting system in 8 patients who had less-than-1-cm-thick renal parenchyma between the mass and the renal sinus or calices. In the remaining 9 patients, who had 1-cm-or-more-thick renal parenchyma between the mass and sinus or calices, renal bleeding was controlled using ultrasonic scissors, gauze tampon, argon beam coagulator, and fibrin glue.


RESULTS
Sixteen patients were successfully treated with laparoscopy; one required conversion to open surgery because of uncontrollable bleeding. The average operative time was 4.5 hours, and average estimated bleeding volume was 301 mL. In the 8 patients requiring vascular clamping by forceps, the average ischemic time was 25 minutes. In all patients, the tumor mass was completely removed with negative surgical margins, and renal function was preserved. Three patients had prolonged urinary leakage for a mean of 21 days.


CONCLUSIONS
Laparoscopic partial nephrectomy offers many advantages, including surgery that is both nephron sparing and minimally invasive. A vascular clamp was indicated for patients with less-than-1-cm-thick renal parenchyma between the tumor mass and renal sinus or calices.
Department of Urology, Nagoya University Graduate School of Medicine, Nagoya City, Aichi, Japan.
Yoko
Y
Yoshikawa
Yoshinari
Y
Ono
Ryohei
R
Hattori
Momokazu
M
Gotoh
Yasushi
Y
Yoshino
Satoshi
S
Katsuno
Masashi
M
Katoh
Shinichi
S
Ohshima
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000601:surgery*; D003250:Constriction; D004564:Electrocoagulation; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000627:therapeutic use; D005500:Follow-Up Studies; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D007564:Japan; D007680:Kidney Neoplasms / Q000098:blood supply / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D017075:Laser Coagulation; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications; D013525:Surgical Instruments; D015503:Surgical Sponges; D016896:Treatment Outcome
D015718:Fibrin Tissue Adhesive