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Complex laparoscopic partial nephrectomy for renal hilar tumors.
Karen Reisiger1, Ramakrishna Venkatesh, Robert S Figenshau
1Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA.
Urology
|May 11, 2005
Summary
Laparoscopic partial nephrectomy (LPN) is a viable option for hilar tumors, though it carries an increased risk of urine leak. Preoperative ureteral catheterization and postoperative stenting may help mitigate this complication.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Oncology
Background:
- Laparoscopic partial nephrectomy (LPN) has advanced, enabling treatment of complex renal tumors.
- Tumors near the renal hilum present unique surgical challenges.
Purpose of the Study:
- To assess the feasibility and outcomes of LPN for tumors adjacent to the renal hilum.
- To identify potential complications and suggest preventive measures for hilar LPN.
Main Methods:
- Retrospective review of 8 patients undergoing LPN for hilar tumors (within 5 mm of hilar vessels).
- Analysis of operative time, blood loss, morbidity, and postoperative course.
- Hilar tumors defined as those within 5 mm of the renal hilar vessels.
Main Results:
- Successful LPN in all 8 patients without conversion to open surgery.
- Mean operative time: 3.0 hours; Mean estimated blood loss: 188 mL.
- Negative surgical margins achieved in all cases; 9 postoperative complications in 6 patients, notably 4 urine leaks.
Conclusions:
- LPN is a reasonable surgical choice for hilar tumors with sufficient laparoscopic expertise.
- Increased risk of urine leak observed; preoperative ureteral catheter and postoperative stenting recommended.
- These measures may reduce the incidence of urine leaks following hilar LPN.