[Laparoscopic transperitoneal partial nephrectomy for a tumor of the upper segment]

Laparoscopic resection of upper pole kidney tumors is a technically challenging procedure. When tumors are located on the dorsal side of the kidney, the renal-rotation technique may facilitate laparoscopic partial nephrectomy.

To present the technique and results of laparoscopic partial nephrectomy (LPN) for tumors of the upper pole of the kidney with its rotation around the renal hilum.

The study presents a retrospective analysis of the results of 12 patients who underwent LPN for upper pole kidney tumors using the renal-rotation technique. The kidney with the renal hilar vessels and the upper third of the ureter were mobilized using a transperitoneal access. Then the kidney was rotated over its pedicular axis so that the upper pole was located inferiorly. As a result, the posterior upper pole tumor was located anteriorly, thereby facilitating its resection. After removing the tumor and confirming homeostasis, the kidney was returned to its original position.

The results of LPN using this technique were successful in all 12 patients. The mean operative time was 120+/-35.0 (90-210) min, the warm ischemia time was 14.5+/-7.8 (10-26) min, and the blood loss was 120.0+/-65.5 (60-300) ml. The intraoperative complication occurred in 1 (8.3%) patients, postoperative complications were observed in 3 patients. Histopathology showed that 11 (91.7%) patients had renal cell carcinoma and one (8.3%) had angiomyolipoma. Analysis of early (18.6+/-5.0 months) oncological outcomes showed no local recurrence and distant metastases.

With dorsally located upper pole kidney tumors, the renal-rotation technique facilitates the performance of LPN and minimizes the risk of intra- and postoperative complications. This method requires the maximum mobilization of the kidney along with the renal hilar vessels and the upper third of the ureter to rotate it for optimal resection conditions.

Urologiia (Moscow, Russia : 1999). 2017 Dec [Epub]

B G Guliev, Kh Kh Yagubov

Department of Urology, I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia.