title: Laparoscopic partial nephrectomy for multiple ipsilateral renal tumors using a tailored surgical approach.
abstract: OBJECTIVE
  Laparoscopic partial nephrectomy (LPN) is safe and effective for solitary renal masses, but its application to multiple ipsilateral renal tumors has been reported infrequently. We review our experience with LPN for multiple ipsilateral renal tumors to assess its role in current practice.
  
  
  METHODS
  We have managed seven patients with multiple ipsilateral renal tumors with LPN. Of the patients, four had an imperative indication for nephron-sparing surgery.
  
  
  RESULTS
  Among the 16 tumors resected, with a mean size of 2.1 cm, 9 (in five patients) were renal cell carcinoma on final pathology. LPN was performed without hilar clamping in four patients (no-clamp group), and with hilar clamping and a sutured bolster in three patients (clamp-suture group). The no-clamp group had a lower mean operative time than the clamp-suture group (185 vs. 225 minutes), similar mean estimated blood loss (363 vs. 417 mL), and shorter hospital stay (1.8 vs. 3 days). The only complication was an intraoperative hemorrhage necessitating blood transfusion, and there was one focal-positive margin, both in patients in the clamp-suture group. Among the five patients with cancer, there have been no local recurrences or metastases during a mean radiographic follow-up of 48 months.
  
  
  CONCLUSIONS
  LPN, with a tailored approach that spares some patients from renal ischemia, appears to be safe and effective in this small series of selected patients with multiple ipsilateral renal tumors.
authors.affiliation: Department of Urology, University of Michigan Health System, Ann Arbor, Michigan 48109-5330, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Flum
authors.forename: J Stuart
authors.initials: JS
authors.lastname: Wolf
mesh_terms: D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D019990:Perioperative Care; D014057:Tomography, X-Ray Computed