Laparoscopic partial nephrectomy for a renal tumor with tumor-feeding artery ligation: left renal cell carcinoma in the posterior mid zone.
The most serious problem regarding a laparoscopic partial nephrectomy is how to perform bloodless excision without causing renal ischemia in a limited working space. We report the case of a 65-year-old man with left small renal cell carcinoma in the posterior mid zone who underwent a laparoscopic partial nephrectomy through a retroperitoneal approach by carrying out the ligation of the tumor-feeding artery, but without clamping the renal pedicle. Both preoperative abdominal computed tomography (CT) and intraoperative ultrasonography revealed the tumor to be fully encapsulated. The tumor-feeding artery could be exposed by dissection from the renal hilum and, after an arterial ligation, tumor resection with a safety margin was smoothly performed with minimal bleeding. Postoperatively, CT revealed a limited defect of the renal parenchyma and excretory pyelography showed no urine leakage or urinary tract obstruction. The preoperative and postoperative creatinine levels were 0.66 and 0.69 mg/dL, respectively. As a result, a tumor-feeding artery ligation with a laparoscopic partial nephrectomy for left renal cell carcinoma in the posterior mid zone is considered to be an effective surgical modality which avoids renal ischemia and pelvic heat injury.
Shichiri
Yasumasa
Y
Department of Urology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan. shichiri@kitano-hp.or.jp
Takao
Noriyasu
N
Oida
Tomoyuki
T
Kanamaru
Hiroshi
H
Shimizu
Yosuke
Y
D000368:Aged; D002292:Carcinoma, Renal Cell / Q000098:blood supply / Q000601:surgery*; D006801:Humans; D007680:Kidney Neoplasms / Q000098:blood supply / Q000601:surgery*; D010535:Laparoscopy; D008026:Ligation; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D012077:Renal Artery / Q000601:surgery*