Off-Clamp Renal Tumourectomy by Retroperitoneoscopy in Posterior Renal Tumours of Medium Complexity (Padua score 8-9)

J. A. Peña, I. Schwartzmann, P. Gavrilov, E. Moncada, J. M. López, J. M. Gaya, M. Oliveira, A. Breda, A. Rosales, J. Palou, H. Villavicencio

Research output: Contribution to journalArticleResearchpeer-review

Abstract

© 2015 AEU. Background The guidelines recommend partial surgery for T1 renal tumours. Various aspects of this surgery have evolved in recent years, including the clamping method and duration, enucleation, the retroperitoneoscopic approach and the use of 3 mm ports. We present our initial series on laparoscopic renal tumourectomy by retroperitoneoscopy (LRTR) and analyse our learning curve and use of 3-mm instrumentation. Material and Methods From January 2011 to January 2015, we performed LRTR on 50 patients with posterior or convex T1 renal tumours. After 10 cases, the technique changed to off-clamp, and 11 cases were subsequently performed with 3 mm instrumentation. Results The mean tumour size was 34.36 mm (14-62), with a mean PADUA score of 8.42 (5-12). The mean operative time was 163.1 minutes (75-300), and the mean warm ischaemia time was 4.21 minutes (0-28). The main renal artery was not clamped in 41 (82%) patients, and no vessel (zero ischaemia) was clamped in 39 (78%) patients. Seven cases had positive margins (6 focal). Eleven LRTRs were performed with 3 mm instrumentation, with shorter surgical times, less intraoperative bleeding and shorter hospital stays. Conclusions Retroperitoneoscopy coupled with enucleation enables the extirpation without clamping of posterior renal tumours, with a relatively short learning curve. The 3-mm material enables the technique to be performed, although in our experience it has resulted in a higher rate of positive surgical margins.
Original languageEnglish
Pages (from-to)11-16
JournalActas Urologicas Espanolas
Volume40
Issue number1
DOIs
Publication statusPublished - 1 Jan 2016

Keywords

  • Laparoscopy
  • Minilaparoscopy
  • Off-clamp
  • Partial nephrectomy
  • Retroperitoneoscopy

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