Lateroconal fascia suspension facilitates retroperitoneal partial nephrectomy

Area of Science:

• Urology
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Increasing incidental detection of renal masses necessitates advanced surgical techniques.
• Laparoscopic partial nephrectomy (LPN) is standard for renal cell carcinoma (RCC).
• Retroperitoneal laparoscopic partial nephrectomy (RLPN) is preferred, but lateroconal fascia poses a visual challenge.

Purpose of the Study:

• To evaluate the efficacy of lateroconal fascia suspension (LFS) in managing the visual obstruction during RLPN.
• To assess the safety and feasibility of the LFS technique in RLPN procedures.

Main Methods:

• Retrospective analysis of 28 RCC patients undergoing RLPN between October 2018 and December 2020.
• Implementation of a novel lateroconal fascia suspension (LFS) procedure using Hem-o-lock clips and sutures.
• Standardized data collection on surgical outcomes, including operative time, blood loss, and ischemia time.

Main Results:

• Successful RLPN completion in all cases without conversion to open surgery.
• Effective management of the 'curtain effect' caused by the lateroconal fascia, improving surgical field of view.
• Median operative time: 142 minutes, median estimated blood loss: 93 mL, median warm ischemia time: 29 minutes.

Conclusions:

• Lateroconal fascia suspension (LFS) is an effective method for managing the 'curtain effect' in RLPN.
• LFS is a simple, economical, and minimally invasive technique.
• This approach enhances surgical efficiency and visualization during RLPN for renal tumors.