Paul Panayotopoulos1, Antoine Bouvier2, Louis Besnier2, Marie Christine Rousselet3, Cosmina Nedelcu2, Nathalie Baize4, Laurent Beydon5, Christophe Aubé2, Abdel-Rahmène Azzouzi6, Pierre Bigot6. 1. Urology, Centre Hospitalier Universitaire d'Angers, Hôtel Dieu, 4 rue Larrey, 49100 Angers, France. Electronic address: paul.panayotopoulos@gmail.com. 2. Radiology, Centre Hospitalier Universitaire d'Angers, Hôtel Dieu, 4 rue Larrey, 49100 Angers, France. 3. Pathology, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49100 Angers, France. 4. UTTIOM Unité Transversale de Thérapeutiques Innovantes en Oncologie Médicale, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49100 Angers, France. 5. Anesthesiology, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49100 Angers, France. 6. Urology, Centre Hospitalier Universitaire d'Angers, Hôtel Dieu, 4 rue Larrey, 49100 Angers, France.
Abstract
PURPOSE: In order to limit ischemia and operative bleeding during and after partial nephrectomy we developed a clampless laparoscopic technique, in a hybrid operating room, immediately after super-selective arterial embolization of the renal tumor. We evaluated feasibility and morbidity of this new approach of zero ischemia in partial nephrectomy. METHODS: We included prospectively 50 consecutive patients treated in a hybrid operating room by this new technique for a localized renal tumor in a university hospital between May 2015 and January 2017. We evaluated perioperative data, postoperative complications, surgical margin and modification of renal function one month after surgery. Renal tumor complexity was evaluated by the R.E.N.A.L. score. RESULTS: We included 30 (60%) men and 20 (40%) women with a median age of 61 years (32-84) and a median BMI of 26.85 kg/m2 (20.1-46.4). Tumors were at low, median and high complexity in respectively 11 (22%), 32 (64%) and 7 (14%) cases. Median endovascular and surgical procedures durations were 43 min (16-120) and 80 min (32-150). Median blood loss was 100 mL (10-850). Two Clavien II complications occurred. Median length of hospital stay was 3 days (2-7). Renal function was not modified one month after partial nephrectomy. Median tumor size was 3 cm (1.2-8). Forty tumors (80%) were malignant and surgical margins were positive in one (2%). CONCLUSIONS: Clampless laparoscopic partial nephrectomy in a hybrid operating room without pedicular dissection after previous tumoral embolization is a technically safe and carcinologically efficient mini-invasive alternative for the management of localized renal tumors.
PURPOSE: In order to limit ischemia and operative bleeding during and after partial nephrectomy we developed a clampless laparoscopic technique, in a hybrid operating room, immediately after super-selective arterial embolization of the renal tumor. We evaluated feasibility and morbidity of this new approach of zero ischemia in partial nephrectomy. METHODS: We included prospectively 50 consecutive patients treated in a hybrid operating room by this new technique for a localized renal tumor in a university hospital between May 2015 and January 2017. We evaluated perioperative data, postoperative complications, surgical margin and modification of renal function one month after surgery. Renal tumor complexity was evaluated by the R.E.N.A.L. score. RESULTS: We included 30 (60%) men and 20 (40%) women with a median age of 61 years (32-84) and a median BMI of 26.85 kg/m2 (20.1-46.4). Tumors were at low, median and high complexity in respectively 11 (22%), 32 (64%) and 7 (14%) cases. Median endovascular and surgical procedures durations were 43 min (16-120) and 80 min (32-150). Median blood loss was 100 mL (10-850). Two Clavien II complications occurred. Median length of hospital stay was 3 days (2-7). Renal function was not modified one month after partial nephrectomy. Median tumor size was 3 cm (1.2-8). Forty tumors (80%) were malignant and surgical margins were positive in one (2%). CONCLUSIONS: Clampless laparoscopic partial nephrectomy in a hybrid operating room without pedicular dissection after previous tumoral embolization is a technically safe and carcinologically efficient mini-invasive alternative for the management of localized renal tumors.