Tumor enucleation vs sharp excision in minimally invasive partial nephrectomy: technical benefit without impact on functional or oncologic outcomes.
OBJECTIVE
To present the benefits and utility of tumor enucleation as an alternative technique to sharp excision during minimally invasive partial nephrectomy (MIPN).


METHODS
We retrospectively compared enucleation and sharp excision during MIPN, with the aim of determining benefits and limitations of enucleation in this setting.


RESULTS
Among 602 patients undergoing MIPN at our institution, 86 and 516 underwent enucleation and sharp excision, respectively, as determined by the surgeon. The nephrometry score was greater in the enucleation vs sharp excision group (mean, 6.7 vs 6.3), but all other preoperative parameters were similar. The mean ischemia and operative times were 4 and 32 minutes shorter in the enucleation group, respectively, likely owing to less frequent entry into renal sinus (21% vs 41%) and need for tumor bed suturing (41% vs 62%), compared with those in the sharp excision group. There was no association with blood loss, positive margins, urine leak, blood transfusion, major complications, renal function, recurrence, or survival.


CONCLUSIONS
Enucleation appears to provide the benefits of reduced surgical entry into the renal sinus, less need for tumor bed suturing, and shorter operative time, without any impact on functional or oncologic outcomes. Given favorable preoperative radiography and intraoperative findings, enucleation is a useful technique for patients undergoing MIPN.
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Anudeep
A
Mukkamala
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Christopher L
CL
Allam
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Jonathan S
JS
Ellison
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Khaled S
KS
Hafez
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
David C
DC
Miller
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Jeffrey S
JS
Montgomery
Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Alon Z
AZ
Weizer
Department of Urology, University of Michigan Health System, Ann Arbor, MI. Electronic address: wolfs@umich.edu.
J Stuart
JS
Wolf
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010149:Postoperative Pain / Q000453:epidemiology / Q000503:physiopathology; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome