Retroperitoneoscopic Partial Nephrectomy for Moderately Complex Ventral Hilar Tumors: Surgical Technique and Trifecta Outcomes from a Single Institution in China.
OBJECTIVE
T1 ventral renal hilar tumors (VRHTs) represent a very special type of tumor, for which laparoscopic partial nephrectomy (LPN) by the retroperitoneal approach is challenging. In this study, we report our surgical technique and Trifecta results.


METHODS
Renal rotation technique has been established for retroperitoneal laparoscopic partial nephrectomy (RLPN) for VRHTs in our institution. Trifecta was used as a composite outcome measure for assessing quality of PLPN using this technique. A retrospective analysis of RLPN cases in 12 patients with VRHTs was performed.


RESULTS
Mean tumor size was 3.4 cm and median R.E.N.A.L. score was 8 (range 7-9). Mean warm ischemia time was 23.1 minutes, suture time 28.1 minutes, estimated blood loss 139.2 mL, operation time 122.8 minutes, and median hospital stay was 4 days. Three patients (25.0%) had Clavien-Dindo grade I-II complications. Seven patients (58.3%) achieved Trifecta. Postoperative pathological examination showed renal cell carcinoma in all cases with negative surgical margin. A median follow-up of 7 months revealed no local recurrence or distant metastases.


CONCLUSIONS
Our Trifecta outcomes demonstrate that RLPN with renal rotation technique is feasible, safe, and effective for moderately complex VRHTs. The short-term functional and oncologic outcomes are promising; however, long-term follow-up is needed.
Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, People's Republic of China .
Longfei
L
Liu
Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, People's Republic of China .
Lin
L
Qi
Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, People's Republic of China .
Yangle
Y
Li
Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, People's Republic of China .
Minfeng
M
Chen
Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, People's Republic of China .
Chao
C
Li
Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, People's Republic of China .
Xu
X
Cheng
Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, People's Republic of China .
Peihua
P
Liu
Department of Urology, Xiangya Hospital, Central South University , Changsha, Hunan, People's Republic of China .
Xiongbing
X
Zu
D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000601:surgery; D002681:China; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009392:Nephrectomy / Q000379:methods*; D061646:Operative Time; D011183:Postoperative Complications; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D052096:Warm Ischemia
Trifecta outcomes; hilar tumor; laparoscopy; partial nephrectomy; renal cell carcinoma; retroperitoneal approach