title: Laparoscopic partial nephrectomy in solitary kidney.
abstract: OBJECTIVE
  We report our experience with LPN for tumor in a solitary kidney.
  
  
  METHODS
  Of 430 patients undergoing LPN since February 1999 at our institution 22 (5%) underwent LPN for tumor in a solitary kidney, as performed by a single surgeon. The laparoscopic technique that we used duplicated open principles, including hilar clamping, cold cut tumor excision and sutured renal reconstruction.
  
  
  RESULTS
  Mean tumor size was 3.6 cm (range 1.4 to 8.3, median 3 cm), median blood loss was 200 cc (range 50 to 500), warm ischemia time was 29 minutes (range 14 to 55), total operative time was 3.3 hours (range 2.2 to 4.5) and hospital stay was 2.8 days (range 1.3 to 12). Two cases (9%) were electively converted to open surgery. Pathological findings confirmed renal cell carcinoma in 16 patients (73%) with negative surgical margins in all those with LPN. Major complications occurred in 3 patients (15%) and minor complications developed in 7 (32%). Median preoperative and postoperative serum creatinine (1.2 and 1.5 mg/dl) and estimated glomerular filtration rate (67.5 and 50 ml per minute per 1.73 m2) reflected a change of 33% and 27%, respectively, which appeared proportionate to the median amount of kidney parenchyma excised (23%). One patient (4.5%) required temporary hemodialysis. At a median followup of 2.5 years (range 0.5 to 4.5) cancer specific and overall survival was 100% and 91%, respectively. No patient with LPN had local or port site recurrence, or metastatic disease.
  
  
  CONCLUSIONS
  LPN can be performed efficaciously and safely in select patients with tumor in a solitary kidney. To our knowledge we present the largest series in the literature. Advanced laparoscopic experience and expertise are necessary in this high risk population.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. gilli@ccf.org
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
authors.forename: Jose R
authors.initials: JR
authors.lastname: Colombo
authors.forename: Alireza
authors.initials: A
authors.lastname: Moinzadeh
authors.forename: Antonio
authors.initials: A
authors.lastname: Finelli
authors.forename: Osamu
authors.initials: O
authors.lastname: Ukimura
authors.forename: Kay
authors.initials: K
authors.lastname: Tucker
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.forename: Mihir
authors.initials: M
authors.lastname: Desai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*