1105 GASLESS SINGLE-PORT CLAMPLESS PARTIAL NEPHRECTOMY FOR PERIPHERAL RENAL TUMOR SURGICAL, SHORT-TERM ONCOLOGICAL, AND FUNCTIONAL OUTCOMES (2012)

You have accessJournal of UrologyKidney Cancer: Localized I1 Apr 20121105 GASLESS SINGLE-PORT CLAMPLESS PARTIAL NEPHRECTOMY FOR PERIPHERAL RENAL TUMOR SURGICAL, SHORT-TERM ONCOLOGICAL, AND FUNCTIONAL OUTCOMES Kazunori Kihara, Fumitaka Koga, Hitoshi Masuda, Kazutaka Saito, Manabu Tatokoro, Minato Yokoyama, Yoh Matsuoka, Noboru Numao, Satoru Kawakami, and Yasuhisa Fujii Kazunori KiharaKazunori Kihara Tokyo, Japan More articles by this author , Fumitaka KogaFumitaka Koga Tokyo, Japan More articles by this author , Hitoshi MasudaHitoshi Masuda Tokyo, Japan More articles by this author , Kazutaka SaitoKazutaka Saito Tokyo, Japan More articles by this author , Manabu TatokoroManabu Tatokoro Tokyo, Japan More articles by this author , Minato YokoyamaMinato Yokoyama Tokyo, Japan More articles by this author , Yoh MatsuokaYoh Matsuoka Tokyo, Japan More articles by this author , Noboru NumaoNoboru Numao Tokyo, Japan More articles by this author , Satoru KawakamiSatoru Kawakami Tokyo, Japan More articles by this author , and Yasuhisa FujiiYasuhisa Fujii Tokyo, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1213AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Since vascular clamping induces renal ischemia and reperfusion injury, clampless partial nephrectomy (PN) is ideal to maximally preserve renal function. We have developed gasless laparoendoscopic single-port surgery (GasLESS) for urological tumors (Int J Urol 2009); its video is available in the EAU video library for several surgical procedures including GasLESS clampless PN (#160204). We evaluated feasibility, safety, and impact on oncological efficacy and renal function of GasLESS clampless PN for peripheral renal tumors. METHODS Between June 2000 and June 2011, 118 consecutive patients with peripheral renal tumors suggestive of RCC underwent GasLESS PN in an attempt to accomplish the procedure without vascular clamping. Peripheral renal tumors were defined as those not involving the renal sinus, collecting system, renal artery or vein on preoperative CT and MRI. Surgical procedures were completed via a single port, of which the diameter was typically around 4 cm in recent cases. Intraoperative ultrasonography was employed to score precise surgical margin. Ultrasonic coagulating devices were chiefly used for tumor excision. Perioperative complications were graded according to the Clavien-Dindo classification. RESULTS Median PADUA score was 7 (range, 6-9). Vascular clamping was required in a patient (1%) who had four renal tumors (1 RCC and 3 angiomyolipomas) resected. Median (range) operative time and blood loss were 190 min (85-386) and 186 mL (0-3920), respectively. Three patients (3%) required blood transfusion. Median postoperative days to full recovery were 4 days (2-23). Three major (3%, grade 3a urinary leakage) and 18 minor (15%, 4 grade 1 and 14 grade 2) complications were observed. Of 99 RCC patients (pT1a/1b/3a = 92/3/4), surgical margin was positive in 10 patients (10%) and most positive margin sites underwent thermal degeneration pathologically. Mean follow-up period was 33 months (2-126). 3-yr CSS/PFS/RFS rates were 100%. None experienced acute renal failure, required dialysis, or newly developed CKD of eGFR <45 mL/min/1.73 m2 postoperatively. Median percent change in eGFR at 3 months after PN was -3.6% (-36.7 to +26.1) overall and -5.5% (-9.6 to +10.0) for the six patients with imperative indication of PN. CONCLUSIONS GasLESS clampless partial nephrectomy is a technically feasible, safe, and minimally invasive procedure for peripheral renal tumors. Given acceptable oncological outcomes and favorable renal remnant function, this technique may deserve multicenter validation. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e448 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kazunori Kihara Tokyo, Japan More articles by this author Fumitaka Koga Tokyo, Japan More articles by this author Hitoshi Masuda Tokyo, Japan More articles by this author Kazutaka Saito Tokyo, Japan More articles by this author Manabu Tatokoro Tokyo, Japan More articles by this author Minato Yokoyama Tokyo, Japan More articles by this author Yoh Matsuoka Tokyo, Japan More articles by this author Noboru Numao Tokyo, Japan More articles by this author Satoru Kawakami Tokyo, Japan More articles by this author Yasuhisa Fujii Tokyo, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...