Tumor enucleation vs sharp excision in minimally invasive partial nephrectomy: technical benefit without impact on
Anudeep Mukkamala1, Christopher L Allam1, Jonathan S Ellison1
1Department of Urology, University of Michigan Health System, Ann Arbor, MI.
Objective:
To present the benefits and utility of tumor enucleation as an alternative technique to sharp excision during minimally invasive partial nephrectomy (MIPN).
Methods:
We retrospectively compared enucleation and sharp excision during MIPN, with the aim of determining benefits and limitations of enucleation in this setting.
Results:
Among 602 patients undergoing MIPN at our institution, 86 and 516 underwent enucleation and sharp excision, respectively, as determined by the surgeon. The nephrometry score was greater in the enucleation vs sharp excision group (mean, 6.7 vs 6.3), but all other preoperative parameters were similar. The mean ischemia and operative times were 4 and 32 minutes shorter in the enucleation group, respectively, likely owing to less frequent entry into renal sinus (21% vs 41%) and need for tumor bed suturing (41% vs 62%), compared with those in the sharp excision group. There was no association with blood loss, positive margins, urine leak, blood transfusion, major complications, renal function, recurrence, or survival.
Conclusion:
Enucleation appears to provide the benefits of reduced surgical entry into the renal sinus, less need for tumor bed suturing, and shorter operative time, without any impact on functional or oncologic outcomes. Given favorable preoperative radiography and intraoperative findings, enucleation is a useful technique for patients undergoing MIPN.
