title: Laparoscopic partial nephrectomy in renal cell cancer--results and reproducibility by different surgeons in a high volume laparoscopic center.
abstract: OBJECTIVE
  With increasing surgical skills and novel methods of hemostasis laparoscopic Partial nephrectomy has become an attractive treatment option for selected renal tumors. We report techniques, perioperative data and oncological outcome in a single center experience with three different surgeons.
  
  
  METHODS
  Between March 2001 and October 2004, 44 patients underwent laparoscopic transperitoneal partial nephrectomy for exophytic tumors. Median tumor size was 3 cm (1-5 cm). In 25 cases the renal artery was clamped using endoscopic bulldog clamps and tumor resection was performed with scissors or the harmonic scalpel. Hemostasis was achieved by application of FloSeal only; closure of the collecting system with Lahodny sutures was performed, if necessary. Frozen sections were obtained in all cases.
  
  
  RESULTS
  All procedures were successful with no intraoperative complications. Mean surgical time was 210 min (115-355 min); clamping time was 21 min (7-41 min) in 25 cases. In 8 cases suturing of the collecting system was required. Margins were negative in 37 cases, in five cases secondary resection was necessary to achieve negative margin status; in two cases radical nephrectomy was performed. There were no significant differences between surgeons in terms of patient data and results. At a mean follow-up of 15 months (6-37 months) no recurrence was observed.
  
  
  CONCLUSIONS
  Laparoscopic partial nephrectomy using FloSeal is a feasible and safe method for treatment of small renal masses. The technique is reproducible by surgeons who are used to complex laparoscopic procedures like expected in high volume laparoscopic centers.
authors.affiliation: Department of Urology, University Hospital Charité, Campus Mitte, Humboldt-University Berlin, Germany. andreas.wille@charite.de
authors.forename: Andreas H
authors.initials: AH
authors.lastname: Wille
authors.forename: Maximilian
authors.initials: M
authors.lastname: Tüllmann
authors.forename: Jan
authors.initials: J
authors.lastname: Roigas
authors.forename: Stefan A
authors.initials: SA
authors.lastname: Loening
authors.forename: Serdar
authors.initials: S
authors.lastname: Deger
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D015588:Observer Variation; D015203:Reproducibility of Results; D013525:Surgical Instruments; D016896:Treatment Outcome