Use of suspension traction system for renal positioning during laparoscopic partial nephrectomy.
OBJECTIVE
The technical difficulty of laparoscopic partial nephrectomy (LPN) lies mainly in the steps required during warm ischemia time (WIT), which includes tumor excision and renal reconstruction. We present a renal-suspension traction system to place the tumor in stable optimal view during the critical steps of LPN.


METHODS
Thirty-three patients underwent LPN from October 2002 through December 2003. Eight had a renal sling placed intraoperatively because of difficult access to the tumor. Perioperative parameters were assessed. The renal hilum was dissected and the tumor exposed. To keep the tumor oriented perfectly toward the camera and the working ports, a 2-0 braided polyglactin (Vicryl) traction suture was passed through Gerota's fascia, catching the renal capsule; brought out through the abdominal wall; and secured to the skin with a clamp.


RESULTS
All surgical margins were negative. For the traction and nontraction groups, the mean sizes of the tumor were 2.5 cm and 2.2 cm, respectively (P = 0.426). The estimated blood loss was 125 mL and 246 mL respectively (P = 0.041). The WIT average 27.4 minutes and 30.12 minutes (P = 0.470). The surgical time was 192 minutes and 235 minutes respectively, (P = 0.062). Based on our findings, we have devised a renal suspension traction algorithm for specific tumor locations during LPN.


CONCLUSIONS
The renal suspension traction system allows precision in tumor excision and renal reconstruction during the critical steps of LPN. With the renal suspension system we devised, we are able to simplify LPN for tumors located away from optimal port access.
Chien
Gary W
GW
Section of Urology, University of Chicago Pritzker School of Medicine, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
Orvieto
Marcelo A
MA
Chuang
Marc S
MS
Sokoloff
Mitchell H
MH
Gerber
Glenn S
GS
Shalhav
Arieh L
AL
D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009392:Nephrectomy / Q000379:methods*; D011098:Polyglactin 910 / Q000627:therapeutic use; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013536:Suture Techniques; D013537:Sutures; D014143:Traction; D016896:Treatment Outcome
D011098:Polyglactin 910