Ces Urol 2006, 10(1):32-39 | DOI: 10.48095/cccu2006008

Laparoscopic resection of renal tumours

M. Hora¹, J. Klečka¹, T. Ürge¹, J. Ferda², O. Hes³, V. Eret¹

¹ Urologická klinika LF UK a FN, Plzeň

² Radiodiagnostická klinika LF UK a FN, Plzeň

³ Šiklův patologicko-anatomický ústav LF UK a FN, Plzeň

Objective: Laparoscopic resection (LR) of a renal tumour is technically more demanding and has some limitations when compared to open resection (OR). We present our experience with introducing the method and compare LR and OR methodologies.

Methods: From September 2004 to February 2006, a total of 179 renal tumours were treated surgically. In 58 (32.4 %) resection was performed. In 21 of these laparoscopic approach was indicated (36.2 %). We perform LR using hilar clamping followed by resection with scissors and suture of the kidney base and margins with an intracorporeal stitch. In one patient, conversion was performed because of bleeding after releasing the hilum. Twenty completed LRs are evaluated in more detail. LR was compared to 20 ORs from between January 2003 and August 2004 using the Student test.

Results: The operation time in LR was 130.8 ? 20.0 mins, in OR it was 105.8 ? 18.4 mins, p = 0.000197. The duration of hilar clamping (warm ischaemia) in LR was 23.3 ? 6.7 mins, in OR it was 13.3 ? 2.0 mins, p = 0.000002. The length of hospital stay after the surgery was 8.1 ? 3.3 days, in OR it was 8.3 ? 1.8 days, p = 0.786077. Postoperative bleeding which was treated conservatively occurred in two LRs, in OR there was one early infection.

Conclusion: LR is a technically demanding procedure. It may be indicated in about a third of resections. Particularly suitable are tumours growing extrarenally which can be accessed well with laparoscopic instruments. Compared to OR, LR poses a higher risk of bleeding complications and is associated with a longer warm ischaemia time.

Keywords: laparoscopy, retroperitoneoscopy, renal tumour, partial nephrectomy, kidney resection

Published: January 1, 2006