Laparoscopic nephron sparing surgery: evolution in a decade.
OBJECTIVE
To present our experience with laparoscopic nephron sparing surgery (NSS) over a decade.


METHODS
Seventy-eight patients underwent NSS since 1994. Two techniques were used-partial nephrectomy without ischemia (group 1) in 29 patients, and with ischemia (group 2) which was in cold or warm ischemia in 24 and 25 patients respectively. The mean tumour size was 1.97 and 2.2 cm in groups 1 and 2 respectively. Renal reconstruction evolved in our hands during this period. We changed many technical details and now we depend more on clips for securing the sutures rather than free hand knotting.


RESULTS
The mean operative time was 162 and 216 minutes in groups 1 and 2 respectively. Mean ischemia time for patients with cold and warm ischemia was 44.9 and 33.8 minutes respectively. 3 patients in group 2 were converted to open surgery. Mean blood loss was 254 and 212 ml for group 1 and 2 respectively with two major bleedings in group 2. Minor intra-operative complication occurred in 3 patients, and major and minor postoperative complication in 15 patients. At a mean follow-up of 23.9 and 12.2 months for groups 1 and 2 respectively there was no recurrence.


CONCLUSIONS
Warm and cold ischemia have widened the indications for laparoscopic NSS to more complex tumours and allow renal reconstruction with acceptable complication rate.
Abukora
Firas
F
Department of Urology, Elisabethinen Hospital, Elisabethinen Krankenhaus, Fadingerstrasse 1, A-4010 Linz, Austria. firas_abukora@hotmail.com
Nambirajan
Thiagarajan
T
Albqami
Nasser
N
Leeb
Karl
K
Jeschke
Stefan
S
Gschwendtner
Manfred
M
Janetschek
Günter
G
D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009392:Nephrectomy / Q000379:methods* / Q000639:trends; D009399:Nephrons; D011183:Postoperative Complications / Q000453:epidemiology; D013997:Time Factors