title: Gasless laparoendoscopic single-port clampless sutureless partial nephrectomy for peripheral renal tumors: perioperative outcomes.
abstract: OBJECTIVE
  To describe the technical aspects of gasless laparoendoscopic single-port clampless sutureless partial nephrectomy for peripheral renal tumors, and to evaluate its outcomes, including surgical, pathological, and short-term oncological and functional outcomes.
  
  
  METHODS
  Between January 2010 and June 2013, 103 patients with peripheral renal tumors suggestive of renal cell carcinoma underwent gasless laparoendoscopic single-port partial nephrectomy. In all cases, an attempt was made to accomplish partial nephrectomy without vascular clamping using ultrasonic coagulating and bipolar sealing devices. Hemostasis was achieved by coagulation and hemostatic agents without reconstructing the renal parenchyma.
  
  
  RESULTS
  Of the 103 patients, gasless laparoendoscopic single-port partial nephrectomy was accomplished without vascular clamping and parenchymal suture in all but two patients (98%). Median operative time and blood loss were 191 min and 244 mL, respectively. One patient (1%) received allogeneic blood transfusion. The median postoperative time to full recovery was 3 days. Three major complications (3%, all grade 3 urinary leakage) were observed. Of 92 renal cell carcinoma patients, four (4%) had positive surgical margins, most of which underwent thermal degeneration histologically. In 91 non-metastatic renal cell carcinoma patients, 3-year local recurrence-free, progression-free, cancer-specific and overall survival rates were 100%, 99%, 100%, and 100%, respectively (mean follow-up period, 21 months). In the 103 patients, the median percent decrease in estimated glomerular filtration rate 3 months after partial nephrectomy was 2.4%.
  
  
  CONCLUSIONS
  Gasless laparoendoscopic single-port clampless sutureless partial nephrectomy can be accomplished in almost all cases of peripheral renal tumors. This surgery is technically feasible and safe, yielding acceptable short-term oncological outcomes and maximal preservation of renal function.
authors.affiliation: Department of Urology, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kihara
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Koga
authors.forename: Yasuhisa
authors.initials: Y
authors.lastname: Fujii
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Masuda
authors.forename: Manabu
authors.initials: M
authors.lastname: Tatokoro
authors.forename: Minato
authors.initials: M
authors.lastname: Yokoyama
authors.forename: Yoh
authors.initials: Y
authors.lastname: Matsuoka
authors.forename: Noboru
authors.initials: N
authors.lastname: Numao
authors.forename: Junichiro
authors.initials: J
authors.lastname: Ishioka
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Saito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D003250:Constriction; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018365:Neoplasm, Residual; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D015427:Reperfusion Injury / Q000517:prevention & control; D015996:Survival Rate; D013537:Sutures
keywords: clampless sutureless partial nephrectomy; gasless laparoendoscopic single-port surgery; renal tumor; surgical outcomes