SURGICAL AND FUNCTIONAL OUTCOMES OF LESS PARTIAL NEPHRECTOMY
WITHOUT ISCHEMIA
F. Berardinelli, L. Cindolo, F. Neri, F. Tamburro, L. Schips (Vasto)
Aim of the study
To report on surgical and functional outcomes of unclamp LESS nephron-sparing surgery (NSS).
Materials and methods
Prospective evaluation of preoperative and postoperative variables of patients undergoing to the
LESS-NSS without ischemia between April 2009 and March 2012. The indications were single,
exophytic, cortical, small renal masses. The procedure was performed through a transperitoneal
approach. A pararectal open Hasson access technique was preferred. A multichannel port was
used and a combination of articulating, bent and conventional laparoscopic instruments were
used. Demographic data and ASA class-risk, operative time, specimen and tumor size, estimated
blood loss, transfusion requirements, pre- and postoperative renal function and hemoglobin,
length of stays (LOS), oral intake, pain assessment (VAS), complications according to DindoClavien classification were recorded.
Results
Twenty-one patients were included (mean operative time 111±41min, mean blood loss
196±195mL, mean tumor size 2±0.3cm). Neither conversion to open surgery nor transfusions
occurred. Four patients required conversion to standard laparoscopy. We recorded 1 Clavien II, 1
Clavien IIIa, 1 Clavien IV. Pathologic examination revealed: 14 RCC (pT1a), 1
angiomyolipoma, 2 oncocytoma, 5 complex renal cysts. With a postoperative VAS of 2.1±1.2
the LOS was 4.4±1.9 days. At 16±11 months follow-up, neither port-site, local, distant
recurrence nor eGFR variation were detected.
Discussion
LESS unclamp-NSS in selected renal masses is safe and feasible procedure, provides
postoperative outcomes overlapping the standard laparoscopy and ensures subjective satisfaction.
Conclusions
In our opinion the key of success is the rigorous selection of the cases.