title: Laparoscopic partial nephrectomy for a renal tumor with tumor-feeding artery ligation: left renal cell carcinoma in the posterior mid zone.
abstract: 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.
authors.affiliation: Department of Urology, Kitano Hospital, The Tazuke Kofukai Medical Research Institute, Osaka, Japan. shichiri@kitano-hp.or.jp
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Shichiri
authors.forename: Noriyasu
authors.initials: N
authors.lastname: Takao
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Oida
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kanamaru
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Shimizu
mesh_terms: 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*