Laparoscopic and robotic partial nephrectomy without renal ischaemia for tumours larger than 4 cm: perioperative and functional outcomes.
OBJECTIVE
To evaluate the technical feasibility, safety and functional outcomes of zero ischaemia laparoscopic and robotic partial nephrectomy with controlled hypotension for renal tumours larger than 4 cm.


METHODS
We evaluated 121 consecutive patients with American Society of Anaesthesiologists (ASA) scores 1-2 who underwent laparoscopic (n = 70) or robotic (n = 51) partial nephrectomy with controlled hypotension with either tumour size ≤4 cm (group 1, n = 78) or tumour size >4 cm (group 2, n = 43) performed by a single surgeon from December 2010 to December 2011. Operative data, complications, serum creatinine, estimated glomerular filtration rates and effective renal plasma flow calculated from 99mTc-mercaptoacetyltriglycine renal scintigraphy were compared. Differences between groups were evaluated by the Chi-square test and the Student's t test.


RESULTS
A significant difference in mean intraoperative blood loss and postoperative complications was found between the two groups: 168 ml (range: 10-600 ml in group 1) and 205 ml (range: 90-700 ml in group 2); p = 0.005, and 6.4 % versus 18.6 %; p = 0.004, respectively. The mean percentage decrease of ERPF of the operated kidney was 1.8 % in group 1 and 4.1 % in group 2.


CONCLUSIONS
Laparoscopic and robotic partial nephrectomy with controlled hypotension for tumours >4 cm in ASA 1-2 patients was feasible with significant higher intraoperative blood loss and postoperative complications compared to smaller renal masses. The benefits of avoiding hilar clamping to preserve kidney function seem excellent.
Department of Urology, Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144 Rome, Italy. mpurri@yahoo.it
Rocco
R
Papalia
Giuseppe
G
Simone
Mariaconsiglia
M
Ferriero
Salvatore
S
Guaglianone
Manuela
M
Costantini
Diana
D
Giannarelli
Carlo Ludovico
CL
Maini
Ester
E
Forastiere
Michele
M
Gallucci
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000601:surgery; D007511:Ischemia / Q000601:surgery*; D007668:Kidney / Q000502:physiology / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D020127:Recovery of Function; D012371:Robotics / Q000379:methods*; D016896:Treatment Outcome