Ces Urol 2010, 14(1):24-31 | DOI: 10.48095/cccu2010004

Evolution of surgical technique of laparoscopic resection of kidney tumours

Milan Hora¹, Viktor Eret¹, Petr Stránský¹, Tomáš Ürge¹, Jiří Klečka jr.¹, Ondřej Hes², Zdeněk Chudáček³, Jiří Ferda⁴

¹ Urologická klinika LF UK a FN Plzeň

² Šiklův patologicko-anatomický ústav LF UK a FN Plzeň

³ Radiodiagnostické oddělení LF UK a FN Plzeň

⁴ Radiodiagnostická klinika LF UK a FN Plzeň

Aim:
We document at our cohort of laparoscopic resections (LR) of kidney tumours progress in the technique of LR.

Material and methods:
The technique of LF was introduced at our institution in 9/2004. We have performed to 6/2009 together 73 LRs. The LR has been modified in time on basis of our opinion and new technical details published in recent literature.

Results:
We started first LRs in small extrarenal tumours with clamping renal vessels en bloc with small endoclamp and the resection defect was closed with time consuming intracorporeal suture.
The methods have been continuously modified. We prefer in planning of operation multidetector CT including biphasic CT angiography Here are the most substantial changes in technique: clamping renal artery only clamping of complex renal hilum en bloc with extra-corporeal clamp, possibility of application of argon beam coagulator to the bottom of resection, suturing with help of clips with lock (at the bottom absorbable PDS clips, for renorraphy non-absorbable bigger Hem-o-lok? clips), using of thrombin sealant in selected cases. With growing experience, we are able to solve some cases without clamping of renal vessels.

Conclusion:
The refining of the operation technique in LR enables to treat with this technique higher percentage of kidney tumours and results are improved as well. In spite of it, LR is indicated only in highly selected cases. Open resection remains gold standard.

Keywords: kidney tumour, laparoscopy, nephrectomy, resection of kidney

Received: July 7, 2009; Accepted: July 30, 2009; Published: January 1, 2010