title: Retroperitoneal laparoscopic renal tumour enucleation with local hypotension on demand.
abstract: OBJECTIVE
  Laparoscopic partial nephrectomy is the standard treatment for peripheric cT1 renal tumours and is usually performed under warm ischaemia. However, it is important to reduce ischaemia time as much as possible to avoid renal damage. The aim of our study was to investigate the feasibility and safety of our technique and to evaluate short-term functional and oncological results.
  
  
  METHODS
  From June 2010 to December 2012, 54 consecutive patients with T1a-T1b renal tumour were enrolled in a high-volume tertiary institution. All patients underwent laparoscopic enucleation with controlled selective hypotension on demand. Karnofsky performance status scale, R.E.N.A.L. Nephrometry Score and Clavien-Dindo Classification were used to assess patients' status, to stratify patients according to kidney disease and to evaluate complications, respectively. Renal function was evaluated with serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) preoperative and 3, 5, 7 and 90 days postoperatively.
  
  
  RESULTS
  All the procedures were completed laparoscopically. Renal hypotension was necessary in 3/54 cases. Mean intraoperatively blood loss was 210 ± 98 ml. Renal carcinoma was found in 87 % patients. Margins revealed to be positive in 5.5 % cases. Mean hospital stay was 7.2 days. Grade IIIa and IIIb postoperative complications were 5.5 and 11 %, respectively. At 3 months, increase for sCr was 0.04 mg/dL; eGFR reduction was 1.2 ml/min. At a median follow-up of 20 months, there was one local recurrence that happened in a positive margin case.
  
  
  CONCLUSIONS
  Our preliminary results proved laparoscopic enucleation with controlled selective local hypotension on demand to be a feasible, safe and effective technique for T1 renal tumours.
authors.affiliation: Department of Surgical and Biomedical Sciences, Institute of Urological, Andrological Surgery and Minimally Invasive Techniques, Perugia University, Tristano di Joannuccio, 1, 05100, Terni, Italy, a.pansadoro@tiscali.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pansadoro
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cochetti
authors.forename: Francesco
authors.initials: F
authors.lastname: D'amico
authors.forename: Francesco
authors.initials: F
authors.lastname: Barillaro
authors.forename: Michele
authors.initials: M
authors.lastname: Del Zingaro
authors.forename: Ettore
authors.initials: E
authors.lastname: Mearini
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007022:Hypotension / Q000150:complications*; D007668:Kidney / Q000473:pathology / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D012187:Retroperitoneal Space / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome