title: Off-Clamp Renal Tumourectomy by Retroperitoneoscopy in Posterior Renal Tumours of Medium Complexity (Padua score 8-9).
abstract: BACKGROUND
  The guidelines recommend partial surgery for T1 renal tumours. Various aspects of this surgery have evolved in recent years, including the clamping method and duration, enucleation, the retroperitoneoscopic approach and the use of 3mm ports. We present our initial series on laparoscopic renal tumourectomy by retroperitoneoscopy (LRTR) and analyse our learning curve and use of 3-mm instrumentation.
  
  
  METHODS
  From January 2011 to January 2015, we performed LRTR on 50 patients with posterior or convex T1 renal tumours. After 10 cases, the technique changed to off-clamp, and 11 cases were subsequently performed with 3mm instrumentation.
  
  
  RESULTS
  The mean tumour size was 34.36 mm (14-62), with a mean PADUA score of 8.42 (5-12). The mean operative time was 163.1 minutes (75-300), and the mean warm ischaemia time was 4.21 minutes (0-28). The main renal artery was not clamped in 41 (82%) patients, and no vessel (zero ischaemia) was clamped in 39 (78%) patients. Seven cases had positive margins (6 focal). Eleven LRTRs were performed with 3mm instrumentation, with shorter surgical times, less intraoperative bleeding and shorter hospital stays.
  
  
  CONCLUSIONS
  Retroperitoneoscopy coupled with enucleation enables the extirpation without clamping of posterior renal tumours, with a relatively short learning curve. The 3-mm material enables the technique to be performed, although in our experience it has resulted in a higher rate of positive surgical margins.
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España. Electronic address: japena@fundacio-puigvert.es.
authors.forename: J A
authors.initials: JA
authors.lastname: Peña
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España.
authors.forename: I
authors.initials: I
authors.lastname: Schwartzmann
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España.
authors.forename: P
authors.initials: P
authors.lastname: Gavrilov
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España.
authors.forename: E
authors.initials: E
authors.lastname: Moncada
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España.
authors.forename: J M
authors.initials: JM
authors.lastname: López
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España.
authors.forename: J M
authors.initials: JM
authors.lastname: Gaya
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España.
authors.forename: M
authors.initials: M
authors.lastname: Oliveira
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Breda
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España.
authors.forename: A
authors.initials: A
authors.lastname: Rosales
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España.
authors.forename: J
authors.initials: J
authors.lastname: Palou
authors.affiliation: Unidad de Uro-Oncologia, Servicio de Urologia, Fundació Puigvert, Universidad Autónoma de Bárcelona, Barcelona, España.
authors.forename: H
authors.initials: H
authors.lastname: Villavicencio
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003250:Constriction; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology* / Q000601:surgery*; D010535:Laparoscopy / Q000295:instrumentation; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009392:Nephrectomy / Q000193:education / Q000379:methods*; D011446:Prospective Studies; D012187:Retroperitoneal Space
keywords: Laparoscopia; Laparoscopy; Minilaparoscopia; Minilaparoscopy; Nefrectomía parcial; Off-clamp; Partial nephrectomy; Retroperitoneoscopia; Retroperitoneoscopy