Login to Access Video or Poster Abstract: MP49-14
Sources of Funding: none

Introduction

Arterial clamping is often needed for laparoscopic partial nephrectomy (LPN) to control the hemorragic risk. It induces a transitory renal ischemia, the long-term consequences of which are controversial. In order to limit ischemia and operative bleeding we developed a LPN technique without arterial clamping, in a hybrid operating room, after hyperselective tumoral embolization (HSE). We evaluated the feasibility after 36 successive cases.

Methods

Between May 2015 and October 2016, 16 female and 20 male presenting a localized renal tumor were included. Median age and BMI were 59 y (32-82) and 25,9 kg/m2 (20,1-37,4). 11 patients had a biopsy prior to surgery. Three indications of partial surgery were imperative, one was preventive and all other were elective. Respectively 24 and 4 tumors were of moderate and high complexity according to the RENAL Score._x000D_ One singel interventional radiologist performed the HSE of tumoral vessels and controled the vascular exclusion of the tumor. Afterwards one single urologist performed a clampless LPN without dissection of the renal pedicle. If necessary, a suture of the parenchyma was made to control venous bleeding._x000D_

Results

Median endovascular and surgical procedures durations were 45 min (21-120) and 77,5 min (32-150). Median blood loss was 50 mL (10-650). No peroperative transfusion was needed. One surgery was converted to a mini-laparotomy because of toxic fat, in order to control carcinological margins. Two Clavien II complications were a postoperative transfusion on a fragile patient and an unexplained sepsis. Median length of stay was 3,5 days (2-7). The procedure had no impact on renal function after one month of follow-up (p=0,09). Median tumoral size was 3 cm (1,5-8). Twenty-eight tumors (77.8%) were malignant. Surgical margins were postive for one patient (2,8%).

Conclusions

Clampless LPN 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.

Funding

none