Laparoscopic nephron sparing surgery: a multi-institutional European survey of 592 cases.
Laparoscopic Nephron Sparing Surgery (LNSS) is a technically challenging procedure. Technical aspects and the outcome of LNSS are investigated. A total of 592 LNSS procedures were collected from 12 Centres, either in extraperitoneal or transperitoneal fashion. Mean tumor size was 2.2 cm. Eight centers reported on tumor position for a total of 407 cases with 338 exophytic tumors (83%) and 69 deep lesions (17%). Four centers, accounting for 185 cases, did not report on tumor position. All the centers performed their LNSS by clamping the hilum. The warm ischemia time was < 30 min in all the centers. The positive margin rate was 2% (12/592). Hemostatic agents and/or sealant or tissue glues were used in 86% of cases (511/592). Types of sealants used included: gelatine matrix (Floseal), fibrin gel (Tissucol), bovine serum albumin (BioGlue) and cianacrylate (Glubran). Two Centres never used sealants, one center used only sealants without suturing and 9 centers used a combination of sealants and bolstering-sutures. The intraoperative open conversion rate was 3.5% (21/592). Postoperative complications included bleeding in 15/592 (2.5%) and urine leak in 13/592 (2.1%). No tumor seeding was reported. LNSS has similar results of open partial nephrectomy. The use of hemostatic agents and/or sealants or tissue glues during LNSS is largely diffuse in European centers and may be an effective add on reducing bleeding and urine leakage when used in combination with bolstering-suturing.
Celia
Antonio
A
San Bassiano Hospital, Bassano del Grappa, Italy. antoniocelia@inwind.it
Zeccolini
Guglielmo
G
Guazzoni
Giorgio
G
Pansadoro
Vito
V
Disanto
Vincenzo
V
Porpiglia
Francesco
F
Milani
Claudio
C
Abbou
Claude
C
Gaston
Richard
R
Janetschek
Gunter
G
Soomroo
Naeem A
NA
Fornara
P
P
Breda
Alberto
A
Schulam
Peter G
PG
De la Rosette
Jean
J
Laguna
M Pilar
MP
Palou
Jean
J
Breda
Guglielmo
G
D005060:Europe; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D011795:Surveys and Questionnaires