title: Transperitoneal laparoscopic partial nephrectomy using a new technique.
abstract: BACKGROUND
  We report our experience with a new technique for transperitoneal laparoscopic partial nephrectomy with the kidney turned upside down intraoperatively.
  
  
  METHODS
  Laparoscopic partial nephrectomy was performed in 10 patients with upper pole lesions through a transperitoneal approach. Once complete mobilization of the kidney was achieved, it was rotated 180 degrees around the horizontal axis, so that the upper pole was positioned inferiorly. After performing partial nephrectomy, the resection bed was sutured by 2-0 polyglactin sutures and application of Hem-o-Lok clips. Then, the kidney was returned into its normal position and fixed to the abdominal wall.
  
  
  RESULTS
  We performed laparoscopic partial nephrectomy on 9 patients with a contrast-enhancing upper pole kidney mass and 1 patient with a nonfunctioning upper pole. The median tumor size was 58 mm (range, 41 mm to 92 mm). The median operative time was 206 minutes (range, 114 to 262 minutes) and the mean warm ischemia time was 30 minutes (range, 22 to 35 minutes). One patient underwent surgical exploration due to bleeding 6 hours after the operation. Prolonged urine leakage (more than 7 days) was observed in 1 patient, which responded to ureteral stent insertion. Surgical margins were negative in all of the patients. Renal cell carcinoma was histologically diagnosed in patients with a kidney tumor.
  
  
  CONCLUSIONS
  Laparoscopic upper pole partial nephrectomy had acceptable results while the kidney was turned upside down intraoperatively, in terms of operative time and complications. This approach facilitates the procedure by achieving a better field of vision.
authors.affiliation: Urology and Nephrology Research Center and Shaheed Labbafinejad Medical Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran. nouralizadeh@yahoo.com
authors.forename: Akbar
authors.initials: A
authors.lastname: Nouralizadeh
authors.forename: Seyed Amirmohsen
authors.initials: SA
authors.lastname: Ziaee
authors.forename: Abbas
authors.initials: A
authors.lastname: Basiri
authors.forename: Nasser
authors.initials: N
authors.lastname: Simforoosh
authors.forename: Hamidreza
authors.initials: H
authors.lastname: Abdi
authors.forename: Nastaran
authors.initials: N
authors.lastname: Mahmoudnejad
authors.forename: Amir H
authors.initials: AH
authors.lastname: Kashi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010537:Peritoneum