Impact of collecting-system repair during laparoscopic partial nephrectomy.
OBJECTIVE
Laparoscopic partial nephrectomy (LPN) is a complex procedure frequently reserved for small, peripherally located renal tumors. Deep, infiltrating lesions often necessitate collecting system repair (CSR), mandating further intracorporeal suturing and reconstruction. We compared our experience with LPN where CSR was and was not required after tumor resection.


METHODS
Between October 2002 and December 2005, 84 patients underwent LPN. Tumor excision with pelvicaliceal system injury occurred in 52 patients, whereas 32 patients required no CSR. Perioperative and pathologic data were compared in the two groups.


RESULTS
Tumors with CSR were larger (mean 2.9 cm v 2.1 cm for non-CSR procedures; P = 0.001) and had larger pathologic specimen weights (mean 58.2 g v 21.8 g; P = 0.05). Blood loss (mean 210 mL) and hospital stay (mean 2.7 days) were similar in the two groups. Warm ischemia time (WIT) (mean 36.6 v 27.7 minutes; P < 0.001) and operative time (mean 238 v 207 minutes; P = 0.03) were longer in the CSR group. The intraoperative hemorrhage rate (7.7% v 9.4%; P = 0.34) and rate of conversion to open surgery (7.7% v 9.4%; P = 0.29) were similar, as were the incidences of postoperative bleeding (7.7% v 3.1%; P = 0.28) and urinary leakage (1.9% v 0; P = 0.62).


CONCLUSIONS
Laparoscopic partial nephrectomy involving CSR is a technically demanding procedure that necessitates longer WIT and overall surgical time. However, when performed by an experienced laparoscopic surgeon, comparable complication rates and blood loss are observed. Technical variations for hemostasis, such as argon-beam coagulation and FloSeal and the use of the LapraTy clip for pelvicaliceal and parenchymal suture repair may facilitate LPN for more deeply invasive tumors.
Zorn
Kevin C
KC
Section of Urology, University of Chicago Pritzker School of Medicine, Chicago, Illinois 60637, USA. kevinzorn@hotmail.com
Gong
Edward M
EM
Orvieto
Marcelo A
MA
Gofrit
Ofer N
ON
Mikhail
Albert A
AA
Shalhav
Arieh L
AL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery; D007685:Kidney Tubules, Collecting / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D052096:Warm Ischemia