Clinical Study of Three-Dimensional Laparoscopic Partial Nephrectomy for the Treatment of Highly Complex Renal Tumors with RENAL Nephrometry Scores of ≥10 Points

Abstract

Aims. To examine the safety and feasibility of three-dimensional (3-D) laparoscopic partial nephrectomy for clinically complex renal tumors. Materials and Methods. We retrospectively evaluated 76 patients who underwent a 3-D ( $n=42$ ; age, $54.6\pm 12.2$ years) or two-dimensional (2-D) laparoscopic partial nephrectomy ( $n=34$ ; age, $54.8\pm 13.2$ years) for renal tumors with RENAL nephrectomy scores of ≥10 points from the same surgical group between January 2017 and April 2020 in Ningbo Urology and Nephrology Hospital. Mean tumor diameter, operation time, warm ischemic time, amount of intraoperative blood loss, postoperative hospitalization time, hospitalization cost, perioperative complication rate, and renal function were compared. Results. The operation time ( $154.6\pm 45.1$  min) and warm ischemic time ( $22.5\pm 6.8$  min) in the 3-D laparoscopic group were significantly lower than those in the 2-D laparoscopic group ( $193.0\pm 59.2$  min, $p=0.001$ and $28.7\pm 7.8$  min, $p=0.0002$ , respectively). No significant differences in amount of intraoperative blood loss ( $p=0.642$ ), length of postoperative hospital stay ( $p=0.541$ ), perioperative complication rate ( $p=0.860$ ), total hospital cost ( $p=0.641$ ), and renal function changes including estimated glomerular filtration rate and serum creatinine ( $p>0.05$ ) were found between the two groups. Conclusion. Our preliminary experience showed that the 3-D laparoscopic imaging system significantly shortened the operation and renal ischemic times, which are more conducive to partial resection of highly complex renal tumors.