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UROSCAN
Year : 2007  |  Volume : 23  |  Issue : 2  |  Page : 217
 

Are we along the path for laparoscopic partial nephrectomy?


Department of Urology and Renal Transplant, SGPGIMS, Lucknow, India

Correspondence Address:
Naval Khurana
Department of Urology and Renal Transplant, SGPGIMS, Lucknow
India
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Source of Support: None, Conflict of Interest: None


PMID: 19675812

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How to cite this article:
Khurana N, Agarwal S, Srivastava A. Are we along the path for laparoscopic partial nephrectomy?. Indian J Urol 2007;23:217

How to cite this URL:
Khurana N, Agarwal S, Srivastava A. Are we along the path for laparoscopic partial nephrectomy?. Indian J Urol [serial online] 2007 [cited 2019 Oct 15];23:217. Available from: http://www.indianjurol.com/text.asp?2007/23/2/217/32086

Lane BR, Gill IS. 5-year outcomes of laparoscopic partial nephrectomy. J Urol 2007;177:70-4.



   Summary Top


This is the first study addressing five-year outcomes of laparoscopic partial nephrectomy (LPN) in 56 patients, each of whom has completed a minimum of five years of follow-up. Ninety-one per cent of patients had incidentally discovered renal masses with a mean tumor size of 2.9 cm, which were benign in 34% and malignant in 66% and pathological tumor stage was pT1a in 32 (86%). Final surgical margin was positive for cancer in one patient. Median serum creatinine preoperatively and postoperatively was 0.9 and 1.0 mg/dl, respectively. No patient with normal baseline serum creatinine undergoing elective laparoscopic partial nephrectomy had postoperative chronic renal insufficiency (serum creatinine more than 2 mg/dl). At a median follow-up of 5.7 years (range 5.0 to 6.9) no distant recurrence (0%) and a single local recurrence (2.7%) were detected. Overall and cancer-specific survival was 86% and 100%, respectively, at five years.


   Comments Top


Laparoscopic partial nephrectomy is technically feasible with exceptional results at certain high-volume centers of excellence. Nephron spring surgery (NSS) is still greatly underused worldwide despite superior renal functional outcomes[1] and equivalent oncological outcomes compared to radical nephrectomy.[1],[2],[3] This is the greatest challenge facing NSS of any type. Factors preventing worldwide spread are bleeding from vessels and complications associated with opening of pyelocalyceal system. Various hemostatic techniques including hemostatic agents[4] (BioGlue and fibrin glue) have been used to overcome these problems with varying results. None of these pharmaceutical hemostatic agents have been reliably successful in sealing vessels or the collecting system, clinically. To be sure, the "tipping point" for spreading laparoscopic partial nephrectomy throughout the world would occur if the procedure could be reduced to a few simple steps, namely clamp the renal vessels, cut out the tumor, dry the exposed renal surface, layer on the hemostatic agent, wait few minutes, unclamp and close. While we are not there yet, surely we are well along the path.

 
   References Top

1.Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H. Matched comparison of radical nephrectomy vs nephron sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 2000;75:1236-42.  Back to cited text no. 1  [PUBMED]  
2.Lee CT, Katz J, Shi W, Thaler HT, Reuter VE, Russo P. Surgical management of renal tumors 4 cm or less in a contemporary cohort. J Urol 2000;163:730-6.  Back to cited text no. 2  [PUBMED]  
3.Hafez KS, Fergany AF, Novick AC. Nephron sparing surgery for localized renal cell carcinoma: Impact of tumor size on patient survival, tumor recurrence and TNM staging. J Urol 1999;162:1930-3.  Back to cited text no. 3  [PUBMED]  
4.Hidas G, Kastin A, Mullerad M, Shental J, Moskovitz B, Nativ O. Sutureless nephron-sparing surgery: Use of Albumin glutaraldehyde tissue adhesive (BioGlue). Urology 2006;67:697-700.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]




 

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