Evaluation of approach to a kidney in laparoscopic nephron sparing surgery (L NSS) without ischemia in patients with pT1 kidney tumours
Article published in Urologia Polska 2006/59/1.

authors

Mieczysław Fryczkowski, Andrzej Paradysz, Jacek Huk, Tomasz Pawlikowski: Katedra i Klinika Urologii w Zabrzu Śląkiej Akademii Medycznej w Katowicach

keywords

kidney, neoplastic tumor, L NSS without ischemia, surgical approach

summary

The aim of the study. The aim of this study is to evaluate L NSS without ischemia in patients with neoplasmatic pT1 kidney tumors.

Material and method. We analyzed retrospectively charts of 19 patients who underwent L NSS without ischemia. Patients were qualified for the laparoscopic procedure in the same way as to the open one. 11 (57.9%) patients underwent resection of a kidney and 8 (42.1%) tumour excavation with safe margin of kidney parenchyma. In 8 (42.1%) patients L NSS was performed retroperitoneally and in 11 (57.9%) patients transperitoneally. Follow-up ranged from 7 to 99 months (average 44.1 months).

Results. 10 (52.6%) men and 8 (47.4%) women underwent L NSS. The patients' average age was 55.4 years. Most of the tumours were RCC - 15 (78.9%) and 11 (57.9%) were of low grade G1. Mean operation time was 150 min., hospitalization time 5.3 days and convalescence time was 8.8 days. Mean postoperative blood loss was 180 ml. There was no local recurrence or metastases and no conversion to open operation.

Conclusion. 1. Retroperitoneal approach in laparoscopic NSS shortens operation and reconvalescence time and increases costs of perioperative analgesia. This approach is preferred in tumors of lower kidney pole. 2. Transperitoneal approach in laparoscopic NSS is preferred in tumors of upper kidney pole and in tumours of lower diameter than in retroperitoneal operations, while the kidney resection are more frequently performed option. 3. Four years (mean) of follow-up confirmed high safety of laparoscopic NSS in patients operated without ishaemia, no progression of neoplasmatic disease and deaths.

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