Related Experiment Video
Updated: Mar 13, 2026
5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
Published on: April 4, 2025
Laparoscopic partial nephrectomy for multiple (four) tumors
Lessandro Curcio1, Bruno Salama1, Daniel Luis Pinto1
1Hospital Federal Ipanema, RJ, Brasil.
Background:
Nephron sparing surgery (NSS) is well established as the standard of care for most surgical small renal tumors when technically feasible. While the majority of sporadic renal tumors are solitary, multifocal tumors have been reported in 5.4% to 25% of patients with tumors smaller than 5cm. We present a video where we approach, through laparoscopy, four tumors on the same kidney.
Case Study:
Male, 58y, went through a routine abdominal ultrasound which showed a 5cm left kidney nodule. His MRI pointed a total of 4 nodules on his left kidney. The aspect suggested a papillary cancer due to high cellularity and low vascularization. The patient was submitted to partial nephrectomy under ischemia to remove the two largest tumors (in¬ferior pole) and a resection without clamping of the other two ipsilateral tumors.
Result:
We performed the surgery in 2 stages. In the first one, we approached the 2 tumors located on the inferior pole inducing warm ischemia, whereas in the second stage we resected the 2 remaining tumors using the technique without clamping. The surgery lasted 220 minutes, with 800mL of blood loss, not requiring blood transfusion. Ischemia time was 35 minutes. The histopathological analysis confirmed that the 4 tumors were papillary cancer, with free margins.
Conclusion:
NSS can be performed and should be tried in patients with multiple kidney tumors, preferably through lapa¬roscopy or assisted by robot. It can be made either using or not clamping of the pedicle, depending on the RENAL score.
Insights
Nephron sparing surgery (NSS) effectively treats multiple kidney tumors. This laparoscopic approach successfully removed four papillary cancers from one kidney with clear margins, demonstrating NSS feasibility for complex cases.
Area of Science:
- Urology
- Surgical Oncology
- Nephrology
Background:
- Nephron sparing surgery (NSS) is the standard for small renal tumors.
- Multifocal renal tumors occur in 5.4%–25% of patients with tumors <5cm.
- Laparoscopic techniques are increasingly utilized for complex renal tumor resections.
Observation:
- A 58-year-old male presented with four left kidney nodules detected via ultrasound and MRI.
- Imaging suggested papillary renal cell carcinoma due to high cellularity and low vascularization.
- The patient underwent a two-stage partial nephrectomy for the multifocal tumors.
Findings:
- The surgery involved two stages: warm ischemia for inferior pole tumors and non-ischemic resection for others.
- Total operative time was 220 minutes with 800mL blood loss; ischemia time was 35 minutes.
- Histopathology confirmed four papillary renal cell carcinomas with negative surgical margins.
Implications:
- NSS is a viable option for patients with multiple renal tumors.
- Laparoscopic or robotic approaches enhance feasibility and outcomes for NSS in multifocal disease.
- Surgical strategy (clamping vs. non-clamping) should be guided by tumor characteristics like the RENAL score.
More Related Videos
06:39Technical Modification of the Terminal Ureter During Total Transperitoneal Laparoscopic Nephroureterectomy for Upper Urinary Tract Urothelial Carcinoma
Published on: November 22, 2019
12:27Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023