Laparoscopic nephron-sparing surgery for two or more ipsilateral renal tumors.
OBJECTIVE
To review our experience with laparoscopic nephron-sparing surgery in the management of two or more synchronous, ipsilateral renal masses. Minimally invasive nephron-sparing procedures are increasingly used for the treatment of select patients with a single, small renal tumor.


METHODS
Since 1998, we have performed laparoscopic nephron-sparing surgery in 288 consecutive patients, including laparoscopic partial nephrectomy (n = 200) and renal cryotherapy (n = 88). Of these, 13 patients (4.5%) were treated for synchronous ipsilateral renal masses.


RESULTS
A total of 27 renal tumors were treated in 13 patients. The patients were divided into four groups on the basis of the treatment. Group 1 (n = 3) underwent en-bloc laparoscopic partial nephrectomy encompassing both tumors; group 2 (n = 2) underwent individual laparoscopic partial nephrectomy of discrete masses during the same procedure; group 3 (n = 2) had one mass treated with partial nephrectomy and the other mass treated with cryotherapy; and group 4 (n = 6) had all tumors treated with cryotherapy. All cases were completed successfully without conversion to open surgery or laparoscopic nephrectomy. The mean overall operative time was 4.3 hours, and the mean blood loss was 169 mL. No intraoperative complications occurred. Three patients had postoperative complications, none requiring re-exploration. One patient in group 4 developed de novo tumors in the treated kidney, located distant from the cryoablated sites.


CONCLUSIONS
Laparoscopic partial nephrectomy is an emerging, efficacious laparoscopic treatment option for select patients. Laparoscopic cryotherapy is a useful alternative or adjunct to partial nephrectomy. The judicious combination of these complementary techniques further extends the scope of minimally invasive nephron-sparing surgery.
Section of Laparoscopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Andrew P
AP
Steinberg
Mete
M
Kilciler
Sidney C
SC
Abreu
Anup P
AP
Ramani
Christopher
C
Ng
Mihir M
MM
Desai
Jihad H
JH
Kaouk
Inderbir S
IS
Gill
D018207:Angiomyolipoma / Q000000981:diagnostic imaging / Q000601:surgery; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods* / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods* / Q000706:statistics & numerical data; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D009364:Neoplasm Recurrence, Local; D009378:Neoplasms, Multiple Primary / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods* / Q000706:statistics & numerical data; D009399:Nephrons / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed