title: Laparoscopic partial nephrectomy: single center experience with 140 patients--evolution of the surgical technique and its impact on patient outcomes.
abstract: OBJECTIVE
  We analyzed the outcome of laparoscopic partial nephrectomy in 140 patients and defined the evolution of the operative technique and its impact on patient outcomes.
  
  
  METHODS
  Preoperative tumor characteristics, intraoperative parameters (blood loss, ischemia time, complication and conversion rates) and postoperative parameters (complications, surgical margins status and followup) were compared between the initial 30 patients (group 1) and the last 110 (group 2). Statistical analysis was done using the Student t test with p <0.05 considered significant. The impact of modifications in the surgical technique on the outcome of surgery is discussed.
  
  
  RESULTS
  Group 1 consisted of exophytic, peripherally located tumors, whereas in group 2 central and hilar tumors were also included. The 2 groups were also different regarding mean tumor size (2.6 vs 3.9 cm p <0.05), conversion rates (10% vs 2.7%, p <0.05), postoperative complication rates (urine leakage 10% vs 1.4% and reoperation 6% vs 1.8%, p <0.05) and positive margins (10% vs 3.6%, p <0.05). Mean warm ischemia time (32 vs 29 minutes) and blood loss (460 vs 510 ml) were similar (each p >0.05). Renal cell carcinoma was found in 78% and 86% of cases, respectively. Overall 7 cases (5%) had focally positive surgical margins, including 3 in group 1 and 4 in group 2. At followup no tumor recurrences were observed.
  
  
  CONCLUSIONS
  Laparoscopic partial nephrectomy is a challenging procedure with potentially major complications. However, accumulated experience and adherence to a standardized surgical technique translate into improved outcomes.
authors.affiliation: Department of Urology, Sheba Medical Center, Tel Hashomer, Israel. andrein2002@yahoo.com
authors.forename: Andrei
authors.initials: A
authors.lastname: Nadu
authors.forename: Yoram
authors.initials: Y
authors.lastname: Mor
authors.forename: Menachem
authors.initials: M
authors.lastname: Laufer
authors.forename: Harry
authors.initials: H
authors.lastname: Winkler
authors.forename: Nir
authors.initials: N
authors.lastname: Kleinmann
authors.forename: Noam
authors.initials: N
authors.lastname: Kitrey
authors.forename: Jacob
authors.initials: J
authors.lastname: Ramon
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000503:physiopathology; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D012086:Reoperation; D052096:Warm Ischemia