Retroperitoneal laparoscopic partial nephrectomy for moderately complex renal hilar tumors

To report our initial experience in retroperitoneal laparoscopic partial nephrectomy (LPN) for moderately complex renal hilar tumors and summarize the feasibility of the retroperitoneal laparoscopic approach.

14 patients with renal hilar tumors underwent retroperitoneal LPN between June 2010 and January 2012 at our institution. All of the masses were confirmed in the hilar location by computed tomography preoperatively and then evaluated with the R.E.N.A.L. nephrometry scoring system; all were defined as moderately complex lesions. A three-port retroperitoneal approach with a dorsal incision was used in all cases. Patient baseline demographics, perioperative outcomes and pathological characteristics were recorded based on a retrospective data collection and telephone interview.

All operations were performed successfully without conversion to radical nephrectomy or open surgery. Only two complications of perirenal fluid collection occurred, but the patients recovered with active surveillance. Mean operative time was 134.3 min, mean estimated blood loss 133.2 ml, mean warm ischemia time 30.6 min and mean retroperitoneal drainage 2.2 days. Mean postoperative hospital stay was 4.7 days. No recurrence or metastasis occurred in these patients at a mean follow-up of 18.6 months.

Our initial experience suggests that retroperitoneal LPN is a feasible, safe and effective procedure for moderately complex renal hilar tumors. Although it remains technically challenging, this approach can be recommended in some complex cases when in experienced hands.