Laparoscopic partial nephrectomy with selective control of the renal parenchyma: initial experience with a novel laparoscopic clamp.

摘要

OBJECTIVE: To report a laparoscopic device that facilitates regional ischaemia in laparoscopic partial nephrectomy (LPN). PATIENTS AND METHODS: Mimicking the shape of a clamp successfully applied in open PN, we developed a laparoscopic device that allows selective clamping in LPN. After obtaining transperitoneal access to the renal mass, the laparoscopic clamp was placed around the tumour 1-2 cm proximal to the line of resection. After excising the tumour, haemostasis was mainly achieved by applying a haemostyptic agent. RESULTS: Three patients with elective indications had LPN using this novel laparoscopic clamp. The tumours were in the upper and lower pole of the kidney in one and two patients, respectively. The tumour diameter was 2.4, 2.6 and 3.2 cm, and the selective clamping time 23, 27 and 38 min. Blood loss was minimal in all three cases, with no complications after LPN. The final pathology showed a papillary and clear cell renal carcinoma in two and one patients, respectively. There were no positive margins on histological assessment. CONCLUSION: LPN with clamping of the renal parenchyma using this novel device can be used in selected patients with peripheral tumours. Resection of the tumour in a bloodless field is possible. The main advantage is that ischaemia occurs only in the renal parenchyma next to the tumour, facilitating nephron-sparing surgery without being pressed for time.