Laparoscopic partial nephrectomy for hilar tumors.
OBJECTIVE
Partial nephrectomy for hilar tumors represents a technical challenge not only for laparoscopic, but also for open surgeons. We report the technical feasibility and perioperative outcomes of laparoscopic partial nephrectomy (LPN) for hilar tumors.


METHODS
Between January 2001 and September 2004, 25 of 362 patients (6.9%) undergoing LPN for tumor, as performed by a single surgeon, had a hilar tumor. We defined hilar tumor as a tumor located in the renal hilum that was demonstrated to be in actual physical contact with the renal artery and/or renal vein on preoperative 3-dimensional computerized tomography. En bloc hilar clamping with cold excision of the tumor, including its delicate mobilization from the renal vessels, followed by sutured renal reconstruction was performed routinely.


RESULTS
Laparoscopic surgery was successful in all cases without any open conversions or operative re-interventions. Mean tumor size was 3.7 cm (range 1 to 10.3), 4 patients (16%) had a solitary kidney and the indication for LPN was imperative in 10 patients (40%). Pelvicaliceal repair was performed in 22 patients (88%), mean warm ischemia time was 36.4 minutes (range 27 to 48), mean blood loss was 231 cc (range 50 to 900), mean total operative time was 3.6 hours (range 2 to 5) and mean hospital stay was 3.5 days (range 1.5 to 6.7). Histopathology confirmed renal cell carcinoma in 17 patients (68%), of whom all had negative margins. In 2002 or earlier hemorrhagic complications occurred in 3 patients (12%). No kidney was lost for technical reasons.


CONCLUSIONS
LPN can be performed in select patients with a hilar tumor. The technical feasibility reported further extends the scope of LPN. To our knowledge the initial experience in the literature is reported.
Gill
Inderbir S
IS
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. gilli@ccf.org
Colombo
Jose R
JR
Frank
Igor
I
Moinzadeh
Alireza
A
Kaouk
Jihad
J
Desai
Mihir
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology*; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D012082:Renal Veins / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D036542:Tomography, Spiral Computed