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Laparoscopic partial nephrectomy without intracorporeal suturing

Surgical Endoscopy volume 30, pages 1585–1591 (2016)Cite this article

Abstract

Background

Partial nephrectomy has gained wider acceptance as a surgical technique in treating small renal tumors. Laparoscopic partial nephrectomy (LPN) still remains a technically demanding surgery to this day. We present our technique of laparoscopic partial nephrectomy, one that is performed without intracorporeal suturing.

Methods

We performed LPN on 31 patients with localized renal parenchymal tumor (stage T1). The procedures were done from September 2009 to March 2015 at the Kaohsiung Medical University Hospital and the Kaohsiung Municipal Ta-Tung Hospital. Our technique involves the covering of renal defect layer by layer with FloSeal, Tisseel and a fat pad after monopolar coagulation.

Results

Thirty-one patients were included in this study. Mean patient age was 53 years old (range 39–70). Mean tumor size was 2.9 cm (range 1.8–6.3). Mean RENAL nephrometry score was 5.3 (range 4–7). The average operation time was 188 min (range 120–290), and the average warm ischemic time was 19.0 min (range 9–26). Mean estimated blood loss was 171 ml (range 10–650), with no postoperative bleeding among the total 31 patients. No recurrent tumors were identified at a mean follow-up of 29 months postoperatively. The mean change in eGFR was 6.5 (ml/min/m2).

Conclusion

Laparoscopic partial nephrectomy is a feasible surgical method for most patients with stage 1 tumor. Our technique has shown to reduce warm ischemic time significantly and provide patients with excellent functional outcomes without affecting oncological results. With this technique, surgeons can perform LPN with more efficiency and with fewer complications.

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Acknowledgments

This study was supported by a grant from Health and welfare surcharge of tobacco products, Ministry of Health and Welfare (MOHW104-TDU-B-212-124-003); Kaohsiung Medical University Hospital (KMUH103-3R46); Ministry of Science and Technology (MOST 103-2320-B-037-010).

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Affiliations

  1. Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ching-Chia Li, Hsin-Chih Yeh, Hsiang-Ying Lee, Wei-Ming Li, Hung-Lung Ke, Allen Herng Shouh Hsu, Mei Hui Lee, Chia-Chun Tsai, Kuang-Shun Chueh, Chun-Nung Huang, Yii-Her Chou & Wen-Jeng Wu

  2. Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan

    Ching-Chia Li, Hsin-Chih Yeh, Hsiang-Ying Lee, Allen Herng Shouh Hsu, Chia-Chun Tsai & Kuang-Shun Chueh

  3. Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ching-Chia Li, Hsin-Chih Yeh, Wei-Ming Li & Hung-Lung Ke

  4. Department of Urology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Ching-Chia Li, Hsin-Chih Yeh, Wei-Ming Li, Hung-Lung Ke, Chun-Nung Huang, Yii-Her Chou, Chien-Feng Li & Wen-Jeng Wu

  5. Department of Pathology, Chi Mei Foundation Medical Center, Tainan, Taiwan

    Chien-Feng Li

  6. Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan

    Chien-Feng Li

  7. Department of Urology, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan

    Wen-Jeng Wu

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  1. Ching-Chia Li
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  2. Hsin-Chih Yeh
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  6. Allen Herng Shouh Hsu
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  7. Mei Hui Lee
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  8. Chia-Chun Tsai
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  9. Kuang-Shun Chueh
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  10. Chun-Nung Huang
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  11. Yii-Her Chou
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  12. Chien-Feng Li
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  13. Wen-Jeng Wu
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Corresponding author

Correspondence to Wen-Jeng Wu.

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Disclosures

Ching-Chia Li, Hsin-Chih Yeh, Hsiang-Ying Lee, Wei-Ming Li, Hung-Lung Ke, Allen Herng Shouh Hsu, Mei Hui Lee, Chia-Chun Tsai, Kuang-Shun Chueh, Chun-Nung Huang, Yii-Her Chou, Chien-Feng Li and Wen-Jeng Wu declare they have no conflict of interest.

Ethical standard

This study was approved by the appropriate institutional review board at Kaohsiung Medical University Hospital (KMUH-IRB-20130082) and performed according to the ethical standards laid down by the 1964 Declaration of Helsinki.

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Li, CC., Yeh, HC., Lee, HY. et al. Laparoscopic partial nephrectomy without intracorporeal suturing. Surg Endosc 30, 1585–1591 (2016). https://doi.org/10.1007/s00464-015-4382-8

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Keywords

  • Partial nephrectomy
  • LPN
  • Suturing
  • Ischemic time
  • Tisseel