Laparoscopic Heminephrectomy

Our careful expansion of laparoscopic partial nephrectomy indications included select patients with more complex tumors such as upper pole tumor with concomitant adrenalectomy, tumor invading deeply into the parenchyma up to the collecting system or renal sinus, tumor abutting the renal hilum, tumor in a solitary kidney, and more recently, a tumor substantial enough to require heminephrectomy (47,72). Finelli et al. (114) evaluated technical efficacy and outcomes of laparoscopic heminephrectomy for large and/or deeply infiltrating tumors requiring a substantial resection (defined herein as >30%) resection of the renal parenchyma. Since August 1999, 41 patients were deemed to have undergone laparoscopic heminephrectomy (group I). A contemporary group of 41 consecutive patients who underwent laparoscopic partial nephrectomy

(<30% resection) were retrospectively identified for comparison (group II). Preoperative patient demographics were similar, except for a higher BMI (p = 0.02) in group I. Group I had larger tumors (3.7 vs. 2.3 cm, p < 0.001), which were more commonly central (41% vs. 9.8%, p = 0.001) and more deeply infiltrating (p < 0.001) compared to group II. Group I underwent larger parenchymal resections (p < 0.001) and routine pelvicalyceal suture repair (p = 0.002). Warm ischemia time was longer in group I (39 vs. 33 minutes, p = 0.02); however, blood loss (150 vs. 100 mL, p = 0.28) and total operative time (3.7 vs. 3.2 hours, p = 0.09) were comparable between the groups. Analgesic requirements, hospital stay, overall complications, and postoperative serum creatinine were comparable between the groups. On histopathology, all 82 surgical margins were negative. The authors concluded that although laparoscopic heminephrectomy is an advanced procedure, it can be performed efficaciously with equivalent outcomes to outcomes equivalent to those of less substantial resections.

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