title: Feasibility of laparoscopic partial nephrectomy after previous ipsilateral renal procedures.
abstract: OBJECTIVE
  Previous renal surgery has been considered a relative contraindication to laparoscopic partial nephrectomy (LPN) because of perirenal surgical adhesions. We present our experience with LPN in patients with previous ipsilateral renal surgery.
  
  
  METHODS
  Of 679 patients undergoing LPN for a renal mass from September 1999 to November 2006, 25 (3.7%) had undergone previous ipsilateral open or percutaneous renal procedures. The LPN technique included hilar clamping, cold tumor excision, and sutured renal reconstruction. The perioperative outcomes were retrospectively analyzed from a prospectively maintained database.
  
  
  RESULTS
  Previous renal surgery included open surgery in 12 patients (nephro/pyelolithotomy in 8, pyeloplasty in 2, and partial nephrectomy in 2) and percutaneous surgery in 13 (percutaneous nephrolithotomy in 9 and renal biopsy in 4). The mean interval from previous surgery was 6.6 years (range 0.3-34). LPN (16 transperitoneal and 9 retroperitoneal) was successful in all patients. The mean tumor size was 2.5 cm (range 1-5.6), the warm ischemia time was 35.8 minutes (range 22-57), and the estimated blood loss was 215 mL (range 25-600). The mean operative time was 3 hours (range 1.5-4.5), and the hospital stay was 3.1 days (range 1-7.6). Histopathologic examination confirmed renal cell carcinoma in 19 patients (76%). No open conversions were needed, and no kidneys were lost. No intraoperative complications and 3 postoperative complications (12%) developed, including blood transfusion in 1, nausea and epistaxis in 1, and compartment syndrome requiring fasciotomy in 1 patient.
  
  
  CONCLUSIONS
  The results of our study have shown that, in select patients, LPN is feasible after previous ipsilateral renal surgery. However, it can be technically challenging, and adequate previous experience with LPN is necessary.
authors.affiliation: Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
authors.forename: Burak
authors.initials: B
authors.lastname: Turna
authors.forename: Monish
authors.initials: M
authors.lastname: Aron
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Frota
authors.forename: Mihir M
authors.initials: MM
authors.lastname: Desai
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.forename: Inderbir S
authors.initials: IS
authors.lastname: Gill
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008495:Medical Oncology / Q000379:methods*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011859:Radiography; D013997:Time Factors; D000267:Tissue Adhesions; D052096:Warm Ischemia