title: Laparoscopic nephron sparing surgery: a multi-institutional European survey of 592 cases.
abstract: 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.
authors.affiliation: San Bassiano Hospital, Bassano del Grappa, Italy. antoniocelia@inwind.it
authors.forename: Antonio
authors.initials: A
authors.lastname: Celia
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Zeccolini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Guazzoni
authors.forename: Vito
authors.initials: V
authors.lastname: Pansadoro
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Disanto
authors.forename: Francesco
authors.initials: F
authors.lastname: Porpiglia
authors.forename: Claudio
authors.initials: C
authors.lastname: Milani
authors.forename: Claude
authors.initials: C
authors.lastname: Abbou
authors.forename: Richard
authors.initials: R
authors.lastname: Gaston
authors.forename: Gunter
authors.initials: G
authors.lastname: Janetschek
authors.forename: Naeem A
authors.initials: NA
authors.lastname: Soomroo
authors.forename: P
authors.initials: P
authors.lastname: Fornara
authors.forename: Alberto
authors.initials: A
authors.lastname: Breda
authors.forename: Peter G
authors.initials: PG
authors.lastname: Schulam
authors.forename: Jean
authors.initials: J
authors.lastname: De la Rosette
authors.forename: M Pilar
authors.initials: MP
authors.lastname: Laguna
authors.forename: Jean
authors.initials: J
authors.lastname: Palou
authors.forename: Guglielmo
authors.initials: G
authors.lastname: Breda
mesh_terms: D005060:Europe; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D011795:Surveys and Questionnaires