title: Laparoscopic partial nephrectomy: Taipei veterans general hospital experience.
abstract: BACKGROUND
  Laparoscopic partial nephrectomy (LPN) is a definitive therapy in patients with a small renal tumor. The aim of this study was to present our interim results of LPN with its complications and outcomes.
  
  
  METHODS
  We conducted a retrospective chart review of 46 LPNs in 45 patients at Taipei Veterans General Hospital from April 2004 to September 2008. The perioperative data were prospectively collected. The follow-up data, including local recurrence, distant metastasis, and renal function, were recorded.
  
  
  RESULTS
  The mean age of these 45 patients was 54.8 years (range, 26-85 years). Three (6.5%) LPNs were converted to laparoscopic radical nephrectomy. The mean tumor diameter was 3.81 cm (range, 2.0-7.5 cm). The mean operative time was 319 minutes (range, 180-660 minutes). The mean blood loss was 501 mL (range, 20-3,300 mL). Pedicle clamping was performed in 37 (80.4%) cases and the mean warm ischemic time was 56 minutes (range, 24-100 minutes). There were 17 (40.0%) benign cases and 26 (56.5%) renal cell carcinomas, which were stage pT1a in 19 (73.1%) cases, pT1b in 5 (19.2%) cases, pT2 in 1 (3.8%) case, and pT3a in 1 (3.8%) case. The major complication rate was 4.3% (delayed bleeding in 1 case and urine leakage in 1 case). All margins were free for the malignant cases. Neither distant metastasis nor mortality was found. Local recurrence was found in 1 patient. The mean preoperative creatinine was 1.04 mg/dL (range, 0.6-2.4 mg/dL) and the mean elevated creatinine level was 0.10 mg/dL at 3 months (p < 0.05) and 0.13 mg/dL at 6 months (p < 0.05) postoperatively. The function of the operated kidney was reduced by a mean of 21.9% at 3 months (p < 0.05) and 27.7% at 6 months (p < 0.05) postoperatively.
  
  
  CONCLUSIONS
  Although our warm ischemic time and operative time were longer than those of other LPN studies, the interim results of our oncologic and renal functional outcomes were encouraging. Further refinement of the procedure is needed to shorten the warm ischemic time and improve the hemostatic technique. In addition, based on postoperative renal function, LPN does not significantly influence long-term renal function.
authors.affiliation: Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taiwan, R.O.C.
authors.forename: Yi-Shung
authors.initials: YS
authors.lastname: Lin
authors.forename: Hsiao-Jen
authors.initials: HJ
authors.lastname: Chung
authors.forename: Alex T L
authors.initials: AT
authors.lastname: Lin
authors.forename: William J S
authors.initials: WJ
authors.lastname: Huang
authors.forename: Yi-Hsiu
authors.initials: YH
authors.lastname: Huang
authors.forename: Tzu-Pin
authors.initials: TP
authors.lastname: Lin
authors.forename: Kuang-Kuo
authors.initials: KK
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003404:Creatinine / Q000097:blood; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies
chemical_list: D003404:Creatinine