BERKELEY, CA (UroToday.com) - The authors have divided their experience with 84 laparoscopic partial nephrectomies into patients with and without the need for intraoperative collecting system repair. Not surprisingly, the patients requiring collecting system closure, had larger, more endophytic tumors and required a longer operative time (a half hour) and longer warm ischemia time (36 vs. 28 minutes). Despite the longer warm ischemia time, the postoperative creatinine changes were similar in both groups. Of note however, is that while intraoperative complications were similar between the two groups (19-21%), postoperative morbidity was greater in the collecting system closure group (27% vs. 9%) - this included hemorrhage requiring transfusion (7.7%), re-exploration (3.8%), pulmonary embolism (3.8%), as well as urine leakage (1.9%).

To be sure, laparoscopic partial nephrectomy in which collecting system closure is necessary is one of the more technically challenging laparoscopic procedures. To this end, the use of adjuncts such as LapraTy clips (in order to eliminate knot tying), pharmaceutical hemostatics (e.g. FloSeal, fibrin glue, etc.), and the argon beam coagulator is helpful in reducing warm ischemia time while improving hemostasis.

The real question in my mind, is the projected longevity of laparoscopic partial nephrectomy vis a vis the advent and refinement of laparoscopic and percutaneous needle ablative therapy - one wonders if the time is not too far distant when the two most used approaches to treat renal cell cancer will be laparoscopic radical/total nephrectomy (for the large tumor) and laparoscopic/percutaneous needle ablative therapy (for the small tumor).

Interesting times!

K. C. Zorn, E. M. Gong, M. A. Orvieto, O. N. Gofrit, A. A. Mikhail, and A. L. Shalhav

J. Endourology 21(3):315- 320, March 2007

UroToday.com Laproscopic and Robotic Section

UroToday.com Surgical Interventions Library

Written by Ralph V. Clayman, MD, a Contributing Editor with UroToday.

Please log-in or register in order to submit comments.

Powered by AkoComment!