title: Evolution of surgical technique and patient outcomes for laparoscopic partial nephrectomy.
abstract: OBJECTIVE
  To review the operative technique, complication rates, and short-term oncologic efficacy of the first 60 laparoscopic partial nephrectomies performed by a single surgeon and to report changes in our technique and the associated outcomes.
  
  
  METHODS
  Between January 2002 and December 2004, data regarding patient characteristics, intraoperative technique, and outcome of 60 consecutive patients undergoing laparoscopic partial nephrectomy were prospectively collected.
  
  
  RESULTS
  All 60 procedures were successfully completed laparoscopically without conversion to an open or hand-assisted approach. Histopathologic examination revealed renal cell carcinoma in 60% of patients with no positive margins or recurrences at a mean follow-up of 25.3 months. The overall complication rate was 30.0%, with 8 urologic (13.3%) and 10 nonurologic (16.7%) complications.
  
  
  CONCLUSIONS
  With experience, laparoscopic partial nephrectomy is a viable alternative to open partial nephrectomy for small renal masses. At present, energy technologies and surgical pharmaceuticals are helpful adjuncts, but are not reliable for primary hemostasis and collecting system closure. Adaptation of traditional open techniques, including vascular control, excision of the tumor with cold scissors, and suture reconstruction of the collecting system and parenchyma, remain necessary to consistently perform laparoscopic partial nephrectomy successfully.
authors.affiliation: Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA.
authors.forename: Kyle J
authors.initials: KJ
authors.lastname: Weld
authors.forename: Ramakrishna
authors.initials: R
authors.lastname: Venkatesh
authors.forename: Jessica
authors.initials: J
authors.lastname: Huang
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods* / Q000639:trends*; D016896:Treatment Outcome