title: Laser-supported partial laparoscopic nephrectomy for renal cell carcinoma without ischaemia time.
abstract: BACKGROUND
  To date, elective nephron-sparing surgery is an established method for the exstirpation of renal tumors. While open partial nephrectomy remains the reference standard of the management of renal masses, laparoscopic partial nephrectomy (LPN) continues to evolve. Conventional techniques include clamping the renal vessels risking ischaemic damage of the clamped organ. Thus, new techniques are needed that combine a sufficient tissue incision for exstirpation of the tumor with an efficient coagulation to assure haemostasis and abandon renal vessel clamping in LPN. Laser-excision of renal tumors during laparoscopic surgery seems to be a logical solution.
  
  
  METHODS
  We performed nephron-sparing surgery without clamping of the renal vessels in 11 patients with a renal tumor in exophytic position (mean size 32 mm, ranging 8-45 mm) by laser-supported LPN.
  
  
  RESULTS
  Regular ultrasound monitoring and insertion of a temporary drainage showed no evidence of postoperative hemorrhage. All tumors were removed with a histopathologically confirmed surrounding margin of normal renal tissue (R0 resection). Serum creatinine, hemoglobin, and hematocrit were nearly unaltered before and after surgery.
  
  
  CONCLUSIONS
  The experience won in these patients have confirmed that laser-assisted LPN without clamping of the renal vessels could be a safe and gentle alternative to classic partial nephrectomy in patients with exophytic position of renal tumors.
authors.affiliation: University Medical Center Göttingen, Department of Urology, Georg-August-University, Robert-Koch-Str. 40, 37075, Göttingen, Alemanya. hagen.loertzer@med.uni-goettingen.de
authors.forename: Hagen
authors.initials: H
authors.lastname: Loertzer
authors.forename: Arne
authors.initials: A
authors.lastname: Strauß
authors.forename: Rolf Herrmann
authors.initials: RH
authors.lastname: Ringert
authors.forename: Philine
authors.initials: P
authors.lastname: Schneider
mesh_terms: D000328:Adult; D000368:Aged; D002292:Carcinoma, Renal Cell / Q000175:diagnosis / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D016896:Treatment Outcome