Concurrent Renorrhaphy During Renal Mass Excision in Laparoscopic Nephron-Sparing Surgery: A Novel Surgical Technique

Laparoscopic nephron sparing surgery (NSS) can be performed by mainly 2 methods, offclamp or on-clamp. Continuous bleeding during the off-clamp method may impair the clear visualization of the border between the tumor and parenchyma, even though it is done safely in experienced hands. Therefore, some surgical modifications may be needed during mass excision and renorraphy. In this video brief, we aimed to present a new off-clamp NSS technique and our case series. The difference of this technique from others is that renorrhaphy was performed during mass excision concurrently to reduce the amount of bleeding.

Laparoscopic transperitoneal NSS was performed on a 40-year-old male patient with a lowcomplexity lower pole mass (2.5 × 2 cm) in the right kidney, characterized by a RENAL nephrometry score of 4p. On left lateral decubitus position, after port placement, the ascending colon was medialized and the right ueter was found. The renal pedicle was dissected, and the main renal artery was secured with the vessel loop. After opening Gerota's fascia, the mass was found on the lateral side of lower pole. The excision margin was determined by cautery. A 3-0 V-Loc suture was fixed to the anterior abdominal wall just before mass excision. Along the margin, the renal parenchyma was incised by scissors at a depth of 3-4 mm. Excision continued until there was enough place to pass the suture. Then renorrhaphy was started with the V-Loc suture to reduce bleeding. Suturing continued until reaching to excision limit. Excision continued until serious bleeding occurred. If serious bleeding occurred, suturing was performed again. If there was no bleeding, excision was completed after controlling the tumor base with suturing. Intraperitoneal air pressure was reduced to detect hidden bleeding. Anti-bleeding powder was applied to the excision area. Written informed consent was obtained from the patients who agreed to take part in the study.

The total operative and renorraphy time was 85 and 10 minutes, respectively. The bleeding amount was 150 mL. The pathologic report confirmed a 2.5 × 2 × 2 cm clear cell renal cell carcinoma. No major complications were observed during surgery. After 46 months, there is no local recurrence or metastasis.