title: Laparoscopic partial nephrectomy for multiple (four) tumors.
abstract: BACKGROUND
  Nephron sparing surgery (NSS) is well established as the standard of care for most surgical small renal tumors when technically feasible. While the majority of sporadic renal tumors are solitary, multifocal tumors have been reported in 5.4% to 25% of patients with tumors smaller than 5cm. We present a video where we approach, through laparoscopy, four tumors on the same kidney.
  
  
  METHODS
  Male, 58y, went through a routine abdominal ultrasound which showed a 5cm left kidney nodule. His MRI pointed a total of 4 nodules on his left kidney. The aspect suggested a papillary cancer due to high cellularity and low vascularization. The patient was submitted to partial nephrectomy under ischemia to remove the two largest tumors (in¬ferior pole) and a resection without clamping of the other two ipsilateral tumors.
  
  
  RESULTS
  We performed the surgery in 2 stages. In the first one, we approached the 2 tumors located on the inferior pole inducing warm ischemia, whereas in the second stage we resected the 2 remaining tumors using the technique without clamping. The surgery lasted 220 minutes, with 800mL of blood loss, not requiring blood transfusion. Ischemia time was 35 minutes. The histopathological analysis confirmed that the 4 tumors were papillary cancer, with free margins.
  
  
  CONCLUSIONS
  NSS can be performed and should be tried in patients with multiple kidney tumors, preferably through lapa¬roscopy or assisted by robot. It can be made either using or not clamping of the pedicle, depending on the RENAL score.
authors: Hospital Federal Ipanema, RJ, Brasil.
authors: Lessandro
authors: L
authors: Curcio
authors: Hospital Federal Ipanema, RJ, Brasil.
authors: Bruno
authors: B
authors: Salama
authors: Hospital Federal Ipanema, RJ, Brasil.
authors: Daniel Luis
authors: DL
authors: Pinto
authors: Hospital Federal Ipanema, RJ, Brasil.
authors: Antonio Claudio
authors: AC
authors: Ahouagi
mesh_terms: D002291:Carcinoma, Papillary / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007511:Ischemia; D007668:Kidney / Q000473:pathology; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging / Q000601:surgery*; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D059351:Organ Sparing Treatments