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Laparoscopic partial nephrectomy for selected central tumours: omitting the bolster
Christopher J Weight1, Brian R Lane, Inderbir S Gill
1Section of Laparoscopic and Robotic Urology, Glickman Urologic Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
BJU International
|July 10, 2007
Summary
This study presents a simplified laparoscopic partial nephrectomy (LPN) technique for central kidney tumors, using sutures and sealant instead of bolstered renorrhaphy to reduce warm ischemia time.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Oncology
Background:
- Laparoscopic partial nephrectomy (LPN) for central tumors often involves complex reconstruction.
- Traditional methods like bolstered renorrhaphy can increase warm ischemia time.
Purpose of the Study:
- To describe an alternative LPN technique for selected central tumors.
- To avoid bolstered renorrhaphy and reduce warm ischemia time.
Main Methods:
- A novel technique using intraparenchymal sutures and thrombin sealant was applied to 23 patients.
- Tumor excision was followed by defect closure without bolstered renorrhaphy.
- Prospective data collection on surgical outcomes.
Main Results:
- Median tumor size was 2.5 cm; median warm ischemia time was 20 minutes.
- 80% of the kidney was preserved.
- 17% of patients experienced complications, including hemorrhage and urine leak.
Conclusions:
- LPN defect reconstruction with sutures and sealant is safe for selected central tumors.
- This technique simplifies the procedure and significantly reduces warm ischemia time.
- Lateral tumors are a contraindication due to potential hemorrhage risk.
