Minimally invasive heminephrectomy: feasibility and outcomes

Laparoscopic partial nephrectomy (LPN) has become a well-established treatment for patients with selected renal malignancies. As the skills of urologic laparoscopic surgeons have increased, more complex and larger tumors are now being approached in this manner. Laparoscopic heminephrectomy (LHN), defined as the resection of >30% of a kidney, is described in this article. Standardized nephrometry scoring is used to grade tumor complexity; complications, renal function, and perioperative outcomes are discussed.

One hundred forty-five patients underwent minimally invasive partial nephrectomy. Parameters studied included patient demographics, tumor characteristics, operative time, estimated blood loss (EBL), length of stay (LOS), clamp time, change in renal function over time, and complication rate using the Clavien system.

Twenty-four patients underwent LHN. Patients who had LHN performed had significantly larger tumors (4.7 vs 2.6 cm, P=0.05) with higher nephrometry scoring (6.6 vs 5.0, P=0.007). On univariate analysis, both operative (176.0 vs 151.6 min, P=0.036) and clamp time (29.3 vs 21.9 min, P=0.003) were significantly increased. There was no difference in LOS, EBL, change of renal function over time, or complications.

LHN is efficacious and feasible. Although both operative and clamp times were significantly increased, there was no significant impact on LOS, EBL, change in renal function over time, or complication rate.