Mayo Clinic Scottsdale experience with laparoscopic nephron sparing surgery for renal tumors
Scott D Simon1, Robert G Ferrigni, Donald E Novicki
1Mayo Clinic, Scottsdale, Arizona, USA.
Purpose:
Nephron sparing surgery is an accepted treatment for small renal masses, of which many have been detected incidentally due to the widespread use of advanced imaging techniques. We report our experience with laparoscopic nephron sparing surgery.
Materials And Methods:
From May 2000 to May 2002 a total of 20 laparoscopic partial nephrectomies were performed in 19 patients. The kidney was mobilized to allow adequate dissection, hemostasis and inspection of the kidney. Cautery, a harmonic scalpel and a TissueLink (TissueLink Medical, Inc., Dover, New Hampshire) device were variably used for dissection and hemostasis. Further hemostasis was then achieved using an argon beam laser with Fibrillar (Fibrillar Ethicon, Somerville, New Jersey), fibrin glue or the TissueLink device. Intact removal and biopsy of the lesion base were done to assess margin status.
Results:
Mean patient age was 66 years (range 41 to 80). Mean tumor size was 2.1 cm. (range 1 to 7) and average operative time was 130 minutes (range 60 to 210). Mean hospital stay was 2.2 days. Mean estimated blood loss was 120 ml. (range 20 to 400) and no blood transfusions or conversions to an open procedure were required. Complications included intraoperative fragmentation of a tumor in 1 case, postoperative dyspnea, postoperative bleeding and pneumonia in 1.
Conclusions:
Laparoscopic partial nephrectomy for small renal tumors was performed safely and effectively. Technique depended on the size and location of the mass. Long-term followup is required to compare cancer control with that of open nephron sparing surgery.
Insights
Laparoscopic partial nephrectomy is a safe and effective treatment for small renal masses. This minimally invasive approach offers a shorter hospital stay and minimal blood loss for patients.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Oncology
Background:
- Small renal masses are increasingly detected due to advanced imaging.
- Nephron sparing surgery is a standard treatment for these masses.
- Laparoscopic partial nephrectomy offers a minimally invasive alternative.
Purpose of the Study:
- To report the experience with laparoscopic partial nephrectomy for small renal masses.
- To evaluate the safety and efficacy of this surgical approach.
Main Methods:
- 20 laparoscopic partial nephrectomies were performed on 19 patients between May 2000 and May 2002.
- Various dissection and hemostasis techniques were employed, including harmonic scalpel, TissueLink device, argon beam laser, and fibrin glue.
- Lesion margin status was assessed via intact removal and biopsy.
Main Results:
- The average patient age was 66 years, with a mean tumor size of 2.1 cm.
- Average operative time was 130 minutes, and mean hospital stay was 2.2 days.
- Mean estimated blood loss was 120 ml, with no transfusions or conversions to open surgery required. Complications were infrequent.
Conclusions:
- Laparoscopic partial nephrectomy is a safe and effective procedure for small renal tumors.
- Surgical technique is tailored to tumor size and location.
- Long-term follow-up is necessary to compare oncological outcomes with open surgery.
