Functional and oncological outcomes of 3D clampless sutureless laparoscopic partial nephrectomy for renal tumors with
Carlo Introini1, Antonia Di Domenico1, Marco Ennas1
1Department of Urology, E.O. Ospedali Galliera, Genoa, Italy.
Background:
Renal cell carcinoma still represents 2-3% of all tumors but its mortality is decreased in the last decades due to the early detection of small masses and to the innovative surgical techniques. The aim of our study was to evaluate safety and feasibility of clampless and sutureless laparoscopic partial nephrectomy (CSLPN) in terms of intra- and postoperative functional results, complication rate and oncological outcome.
Methods:
We evaluated patients undergoing CSLPN between July 2013 and December 2019. Inclusion criteria were single, organ confined tumor with size ≤4 cm, intraparenchymal depth ≤1.5 cm, renal nephrometry score between 4 and 6 and no close contact with the collecting system.
Results:
Overall, 62 patients underwent CSLPN. Mean operative time was 105 minutes, mean intraoperative blood loss was 165 mL. Mean drain time and hospital stay were respectively 2.5 and 4.2 days. Mean 24 hours hemoglobin (Hb) decrease was 2.5 g/dL. No significative variations are described in pre- and postoperative renal function. Twelve patients had postoperative complications. At a median follow-up of 38.5 months all the patients are alive and disease free.
Conclusions:
Different techniques have been proposed to reduce warm ischemia time (WIT). In our experience we found many benefits in an off-clamp procedure: it gives an ischemia-related advantage, reduces the overall operating time, eliminates the risks associated with the isolation of hilar vessels. In conclusion CSLPN is a safe and effective procedure for selected renal masses; it does not increase complication rate and offers excellent functional and oncological outcomes.
Insights
Clampless and sutureless laparoscopic partial nephrectomy (CSLPN) is a safe and effective procedure for selected renal masses. This technique offers excellent functional and oncological outcomes without increasing the complication rate.
Area of Science:
- Urology
- Oncology
- Surgical Innovation
Background:
- Renal cell carcinoma (RCC) accounts for 2-3% of all tumors.
- Mortality from RCC has decreased due to early detection and surgical advancements.
Purpose of the Study:
- To evaluate the safety and feasibility of clampless and sutureless laparoscopic partial nephrectomy (CSLPN).
- To assess intra- and postoperative functional results, complication rates, and oncological outcomes of CSLPN.
Main Methods:
- Retrospective evaluation of 62 patients undergoing CSLPN between July 2013 and December 2019.
- Inclusion criteria: single, organ-confined tumors (≤4 cm, ≤1.5 cm depth), nephrometry score 4-6, no collecting system contact.
Main Results:
- Mean operative time: 105 minutes; mean blood loss: 165 mL.
- Mean drain time: 2.5 days; mean hospital stay: 4.2 days.
- No significant changes in renal function; 12 postoperative complications; all patients disease-free at median 38.5 months follow-up.
Conclusions:
- CSLPN offers ischemia-related advantages and reduces operating time by avoiding hilar vessel isolation.
- CSLPN is safe and effective for selected renal masses.
- The procedure yields excellent functional and oncological outcomes without increased complications.
