Preventive sutures in nonischemic laparoscopic partial nephrectomy. Description of S.P. Botkin City Clinical Hospital technique

Abstract

Background. Radical removal of the tumor while maximizing sparing of the renal function are the main goals of the partial nephrectomy. Shortening of the warm ischemia time is one of the best ways to achieve good functional results of the surgery. Aim. To present our technique of non-ischemic laparoscopic kidney resection with preventive suturing around the tumor.Materials and methods. Before tumor resection, sutures are placed around tumor spaced by 1 cm with moderate tension. Enucleoresection is performed between tumor and preplaced sutures in visually healthy plane. 30 patients underwent this technique.Results. Median tumor size was 3.6 (1.5–7.2) cm. All patients had negative surgical margin. Warm ischemia was needed in 8 (26.7 %) patients with a median time of 9 minutes. Median operative time was 115 (65–185) minutes. There were no intra or postoperative complications. Trifecta was achieved in all patients (100 %).Conclusion. This technique allows to perform the surgery in non-ischemic fashion, decrease bleeding and improve visualization of the resection field and achieve superior oncologic and functional results.