title: Hand-assisted laparoscopic partial nephrectomy without formal collecting system closure: perioperative outcomes in 104 consecutive patients.
abstract: OBJECTIVE
  Laparoscopic partial nephrectomy (LPN) paralleling open techniques, particularly closure of the collecting system, can be technically challenging for the novice laparoscopist. We describe operative results and complications of a single surgeon, retrospectively reviewed series using a simplified method of hand assistance and a fibrin glue patch for hemostasis without formal collecting system closure.
  
  
  METHODS
  We identified 104 consecutive patients between September 2003 and January 2009 who underwent hand-assisted laparoscopic partial nephrectomy (HALPN). Our technique involves routine hilar clamping after isolation of the tumor and mobilization of the kidney. After resection of the mass, a fibrin glue patch is placed within the surgical defect and secured with bolstering sutures. No attempt is made to suture the collecting system, nor are ureteral catheters placed when the collecting system is entered during resection of the tumor.
  
  
  RESULTS
  Mean tumor size was 2.8 cm (median 2.5 cm, range 0.7-7.0 cm). With hilar clamping, warm ischemia time averaged 24.5 minutes (range 11-39 min). Estimated blood loss averaged 220 mL (range 50-1500 mL), and five (4.8%) patients received transfusions either intraoperatively or postoperatively. Urine leak occurred in 1.9% (n=2) of patients overall and 4.3% (2/47) of patients with documented collecting system entry. Both urine leaks resolved with conservative management only.
  
  
  CONCLUSIONS
  HALPN without formal collecting system closure is a safe and effective technique with similar urine leak and transfusion rates compared with other series. This technique may allow more urologists to perform minimally invasive partial nephrectomy or to do so with potentially shorter ischemia times.
authors.affiliation: Division of Urology, University of Kentucky Chandler Medical Center and Veterans Affairs Hospital, Lexington, Kentucky, USA.
authors.forename: Jason R
authors.initials: JR
authors.lastname: Bylund
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Clark
authors.forename: Paul L
authors.initials: PL
authors.lastname: Crispen
authors.forename: Chad A
authors.initials: CA
authors.lastname: Lagrange
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Strup
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005340:Fibrinogen / Q000494:pharmacology; D005781:Gelatin Sponge, Absorbable / Q000494:pharmacology; D058733:Hand-Assisted Laparoscopy / Q000379:methods*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D007685:Kidney Tubules, Collecting / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D013537:Sutures; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D005340:Fibrinogen