title: [Combined approach of laparoscopic and open surgery for complex renal lesions].
abstract: OBJECTIVE
  To develop a combined surgical approach (laparoscopic and open) that allows an increased vascular control and decreased ischemia time, maintaining the advantages of pure laparoscopic partial nephrectomy (LPN).
  
  
  METHODS
  During the laparoscopic phase, dissection of the kidney and its pedicle is achieved. Then, an open approach is initiated through a mini-laparotomy, with the kidney being brought to the incision, improving the identification and exposition of the tumors. Following tumor identification by ultrasound, exeresis of the lesion is performed with or without vascular clamping.
  
  
  RESULTS
  Through this approach we performed the excision of complex lesions in 6 patients. Mean surgical time was 192 minutes (range 180-210) and mean warm ischemia time was 13 minutes (0-22), with a mean blood loss of 267 mL (100-500). Average pre and postoperative glomerular filtration rate was 51.5 (28-90) and 48.8 mL/min/1.73 m(2) (19-90), respectively. In one patient, suture repair of the pelvicaliceal system was needed, with no other perioperative morbidities being reported.
  
  
  CONCLUSIONS
  This combined approach is a minimally invasive surgical alternative, reproducible and safe which preserves the virtues of pure LPN. It allows a better control of the vascular pedicle, reducing the risk of hemorrhage and the warm ischemia time. This technique may be either considered in the treatment of renal masses with indication for partial nephrectomy but of complex laparoscopic approach or as a surgical approach in the early learning curve of the LPN.
authors.affiliation: Servicio de Urología, Fundació Puigvert, Barcelona, España. jpalou@fundacio-puigvert.es
authors.forename: J
authors.initials: J
authors.lastname: Palou
authors.forename: M
authors.initials: M
authors.lastname: Oliveira
authors.forename: P
authors.initials: P
authors.lastname: Pardo
authors.forename: J A
authors.initials: JA
authors.lastname: Peña
authors.forename: O
authors.initials: O
authors.lastname: Rodríguez
authors.forename: A
authors.initials: A
authors.lastname: Rosales
authors.forename: H
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000601:surgery*; D010535:Laparoscopy; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*