EAU 2018: Renal Cancer: Partial Nephrectomy, Immediate and Late Complications - Laparoscopic
One of the main differences between LPN and robotic PN is that LPN requires longer ischemia time, which is likely a result of the more challenging type of operation required by performing the laparoscopic approach. Additionally, conversion to radical nephrectomy following LPN is as high as 35%, compared to only 13% for robotic PN – not a subtle difference!
When performing LP, it is important to make decisions early about technique, approach, and surgical strategy. It is also imperative to have good imaging and to understand the renal vasculature very well – even minor bleeding should be avoided as it can be difficult to control laparoscopically in less-skilled hands. The surgeon must anticipate vascular complications and prepare instruments and suture beforehand.
Tricks to address bleeding include known laparoscopic maneuvers such as increasing pneumoperitoneum, using direct pressure, and getting a stich placed as quickly as possible. It is also important, however, to completely mobilize the kidney and have the renal vessels well-exposed. If one experiences significant arterial bleeding, try placing a second clamp or find another renal artery that may need clamping. Address all bleeding in the renal bed and check it by decreasing the pneumoperitoneum. It is better to fix any and all bleeding in the operating room rather than pay for it later!
In general, LPN is difficult and has similar complications to other PN approaches. However, significant technical ability is needed to consistently prevent bad outcomes; and when possible, should only be performed by very experienced surgeons.
Presented by: A. Skolarikos, Athens, Greece
Written by: Shreyas Joshi, MD, Fox Chase Cancer Center, Philadelphia, PA at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark