Laparoscopic Partial Nephrectomy: An Useful Method of Decision Making for Determining the Approach and Surgical Method Based on the Systematic Classification of Tumor Location.
10.4111/kju.2008.49.12.1067
- Author:
Kyung Yun KIM
1
;
Dae Kyung KIM
;
Seung Hyo WOO
;
Eun Tak KIM
;
Seung Bae LEE
Author Information
1. Department of Urology, Eulji University School of Medicine, Daejeon, Korea.
- Publication Type:Original Article
- Keywords:
Laparoscopy;
Nephrectomy;
Warm ischemia;
Kidney neoplasms
- MeSH:
Decision Making;
Follow-Up Studies;
Kidney;
Kidney Neoplasms;
Laparoscopy;
Nephrectomy;
Recurrence;
Warm Ischemia
- From:Korean Journal of Urology
2008;49(12):1067-1073
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Laparoscopic patial nephrectomy is still one of challenging surgeries in laparoscopic urologic field and needs skillful technique of surgeons. When performing laparoscopic partial nephrectomy, initial plan of how to approach affects the whole course of the surgery. To propose a systematic decision guideline, we used the tumor location as the determining factor for selecting initial plan and analyzed our initial experience. MATERIALS AND METHODS: From September 2005 to April 2008, we performed 22 LPNs for small renal tumors less than 40mm in diameter, as measured from the preoperative computed tomography scans. We divided the tumor locations into 18 categories with the combinations of the anterior and posterior renal axes, and the upper, middle, lower parts of the kidney and the peripheral, central and hilar locations of the tumor. According to the tumor location categories, we performed LPNs through the retroperitoneal simple and complex approaches, and the transperitoneal simple and complex approaches. RESULTS: Twenty of twenty-two tumors(91%) were removed successfully through 4 different approaches, but 2 cases were converted to laparoscopic radical nephrectomies(LRNs). The mean operation time was 203 minutes, including a mean warm ischemic time(WIT) of 30.7 minutes. Among the 17 cases of RCC, 15 tumors were successfully removed via LPNs, and there were no cases with positive margins and no tumor recurrence during a mean of 14.9 months follow-up with a maximum follow-up period of 34 months. CONCLUSIONS: Dividing the tumor location into 18 categories is useful for deciding on the appropriate laparoscopic approach.
