title: Synthetic Renal Capsule Tailoring: A Novel Renorrhaphy Technique After Subcapsular Dissection of Renal Tumors with Severe Adherent Perirenal Fat During Laparoscopic Partial Nephrectomy.
abstract: BACKGROUND
  Multiple factors can account for surgical complexity during laparoscopic partial nephrectomy (LPN); severe adhesion of perirenal fat (PRF) is a crucial one. Consequent renal decapsulation can deem renorrhaphy a very challenging task. We propose a novel technique (synthetic renal capsule tailoring [SYRCT]) to facilitate renorrhaphy in decapsulated kidneys and suggest early decapsulation as a safe option in cases with severe PRF.
  
  
  METHODS
  We retrospectively analyzed perioperative results of this novel technique performed in cases with severe PRF. All cases were classified as high grade in the Mayo Adhesive Probability (MAP) score.
  
  
  RESULTS
  A total of six cases were performed with the SYRCT technique. All patients were male with a mean age of 70 years (62-76 years) and mean body mass index of 30 kg/m2(23.66-33.86). Of the six cases, five were T1a and 1 T1b. Mean tumor size was 2.83 cm (range 1.2-6 cm). Mean operative time was 121 minutes (range 74-150 minutes); mean warm ischemia time was 17.2 minutes (range 13-25 minutes). Mean operative bleeding was 128 mL (range 50-250 mL). Mean hospital stay was 2.3 days. There were no surgical complications greater or equal to Clavien II.
  
  
  CONCLUSIONS
  Performing complete renal decapsulation with subcapsular dissection and SYRCT in cases with high MAP score and severe PRF is safe and reproducible. Using this novel technique, we were able to obtain perioperative results comparable to the ones we found in LPN with normal PRF.
authors.affiliation: Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina .
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Vitagliano
authors.affiliation: Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina .
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez
authors.affiliation: Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina .
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Guglielmi
authors.affiliation: Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina .
authors.forename: Mauro
authors.initials: M
authors.lastname: Mieggi
authors.affiliation: Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina .
authors.forename: Leandro
authors.initials: L
authors.lastname: Blas
authors.affiliation: Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina .
authors.forename: Luis
authors.initials: L
authors.lastname: Rico
authors.affiliation: Urolaparoscopic Section, Department of Urology, Hospital Alemán , Buenos Aires, Argentina .
authors.forename: Carlos
authors.initials: C
authors.lastname: Ameri
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D000267:Tissue Adhesions / Q000601:surgery; D016896:Treatment Outcome; D052096:Warm Ischemia
keywords: laparoscopic partial nephrectomy; perirenal fat