title: Superselective embolization as first step of laparoscopic partial nephrectomy.
abstract: OBJECTIVE
  Laparoscopic partial nephrectomy is currently very hard to perform because of the great difficulty in obtaining renal parenchymal hemostasis during tumor excision and the consequent high risk of bleeding. The aim of this study was to propose a method to decrease the risk of bleeding, consisting of the superselective embolization of tumor vessels before performing the laparoscopic partial nephrectomy.
  
  
  METHODS
  Fifty patients with small, solitary, enhancing, predominantly exophytic renal tumors underwent a superselective radiographically guided embolization of tumor vessels. An average of 6 hours after embolization, the patients underwent partial laparoscopic nephrectomy, with transperitoneal access and three trocars placed, under balanced general anesthesia. The mean operative time was measured, as was the mean estimated blood loss.
  
  
  RESULTS
  The mean operative time was 90 minutes, the mean estimated blood loss was 200 mL, and the average hospital stay was 6 days. Complications were reported in only 2 patients. The final pathologic evaluation confirmed the diagnosis of renal cell carcinoma in 43 cases. The median follow-up was 11 months and, to date, the examinations have revealed no recurrences in any of the cases.
  
  
  CONCLUSIONS
  Superselective embolization is a valid option for laparoscopic partial nephrectomy. The procedure does not require any regional vascular control or clamping, reduces the estimated blood loss, and reduces the operative time.
authors: Department of Urology, Regina Elena Cancer Institute, Rome, Italy. gallucci@ifo.it
authors: Michele
authors: M
authors: Gallucci
authors: Salvatore
authors: S
authors: Guaglianone
authors: Livio
authors: L
authors: Carpanese
authors: Rocco
authors: R
authors: Papalia
authors: Giuseppe
authors: G
authors: Simone
authors: Ester
authors: E
authors: Forestiere
authors: Costantino
authors: C
authors: Leonardo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011300:Preoperative Care