Lucio Dell'Atti1, Simone Scarcella2, Stefano Manno2, Massimo Polito2, Andrea B Galosi3. 1. Department of Urology, University Hospital "Ospedali Riuniti", Ancona, Italy. Electronic address: dellatti@hotmail.com. 2. Department of Urology, University Hospital "Ospedali Riuniti", Ancona, Italy. 3. Department of Urology, Polytechnic University of Marche Region, Ancona, Italy.
Abstract
PURPOSE: We report an unclamped sutureless laparoscopic simple enucleation (LSE) technique for renal tumors with low nephrometry score and analyze complication rates as well as functional and oncologic outcomes. PATIENTS AND METHODS: We reviewed the data of 143 consecutive patients who underwent sutureless laparoscopic tumor enucleation with zero ischemia by a single experienced laparoscopic surgeon. The inclusion criteria for LSE with zero ischemia were tumor size ≤ 5 cm and RENAL nephrometry score of 4 to 6. The following data were collected: age, gender, body mass index, tumor side, renal function, tumor characteristics, American Society of Anesthesiologists score, operative time, positive surgical margins, estimated blood loss, and surgical complications. RESULTS: The median RENAL score of patients was 4.7. Median tumor size was 2.7 cm. Conversion to open surgery and hilum vessels clamped were not necessary in any patient. There were no changes in postoperative creatinine values and estimated glomerular filtration rate. The median operation duration time was 78.2 minutes, and median estimated blood loss was 110.2 mL. The median hospital stay was 3.8 days. A total of 2.8% of the patients had positive surgical margins at pathologic examination. Of the 143 patients, 7% developed fever after surgery requiring an adequate antibiotic regimen, 1.4% developed postoperative bleeding requiring blood transfusions, and 0.7% had postoperative urinary leakage from the drainage requiring double-J stent position. CONCLUSION: The unclamped sutureless LSE is a rational and safe approach to renal tumors with a low nephrometry score. This surgical technique does not increase the complication rate despite the reduction in parenchymal mass excised and the absence of hilar control.
PURPOSE: We report an unclamped sutureless laparoscopic simple enucleation (LSE) technique for renal tumors with low nephrometry score and analyze complication rates as well as functional and oncologic outcomes. PATIENTS AND METHODS: We reviewed the data of 143 consecutive patients who underwent sutureless laparoscopic tumor enucleation with zero ischemia by a single experienced laparoscopic surgeon. The inclusion criteria for LSE with zero ischemia were tumor size ≤ 5 cm and RENAL nephrometry score of 4 to 6. The following data were collected: age, gender, body mass index, tumor side, renal function, tumor characteristics, American Society of Anesthesiologists score, operative time, positive surgical margins, estimated blood loss, and surgical complications. RESULTS: The median RENAL score of patients was 4.7. Median tumor size was 2.7 cm. Conversion to open surgery and hilum vessels clamped were not necessary in any patient. There were no changes in postoperative creatinine values and estimated glomerular filtration rate. The median operation duration time was 78.2 minutes, and median estimated blood loss was 110.2 mL. The median hospital stay was 3.8 days. A total of 2.8% of the patients had positive surgical margins at pathologic examination. Of the 143 patients, 7% developed fever after surgery requiring an adequate antibiotic regimen, 1.4% developed postoperative bleeding requiring blood transfusions, and 0.7% had postoperative urinary leakage from the drainage requiring double-J stent position. CONCLUSION: The unclamped sutureless LSE is a rational and safe approach to renal tumors with a low nephrometry score. This surgical technique does not increase the complication rate despite the reduction in parenchymal mass excised and the absence of hilar control.
Authors: Simone Scarcella; Daniele Castellani; Pietro Piazza; Carlo Giulioni; Luca Sarchi; Marco Amato; Carlo Andrea Bravi; Maria Peraire Lores; Rui Farinha; Sophie Knipper; Erika Palagonia; Sérgio Augusto Skrobot; Dries Develtere; Camille Berquin; Céline Sinatti; Hannah Van Puyvelde; Ruben De Groote; Paolo Umari; Geert De Naeyer; Lucio Dell'Atti; Giulio Milanese; Stefano Puliatti; Jeremy Yuen-Chun Teoh; Andrea B Galosi; Alexandre Mottrie Journal: J Robot Surg Date: 2021-11-08