Laparoscopic partial nephrectomy for selected central tumours: omitting the bolster

Abstract

To describe an alternative technique of laparoscopic partial nephrectomy (LPN) for selected central tumours that avoids bolstered renorrhaphy, LPN for such tumours often requires a substantial resection, including collecting-system entry, and renal reconstruction typically requires oversuturing the tumour defect and bolstered renorrhaphy, increasing the warm ischaemia time. After excising the tumour, the tumour bed defect in 23 selected patients was closed with intraparenchymal sutures and biological gelatine matrix-thrombin sealant, with no bolstered renorrhaphy. Data on outcomes during and after surgery were collected prospectively. The median (range) tumour size was 2.5 (1.7-5) cm, the warm ischaemia time 20 (9-44) min, the estimated blood loss 150 (50-1000) mL, and 80 (45-95)% of the kidney was spared. Complications occurred in four patients (17%), i.e. one each with a postoperative haemorrhage with a lateral tumour, requiring surgical re-exploration, a urine leak that resolved spontaneously, postoperative anaemia, and atrial fibrillation. In properly selected patients with a central tumour extending to the collecting system, the LPN defect can be reconstructed safely with a running intraparenchymal haemostatic suture and thrombin sealant, with no bolstered renorrhaphy. The operation is simplified and the warm ischaemia time significantly less. A lateral tumour, wherein the resultant LPN defect faces away from the surgeon, precluding uniform contact of sealant with the entire tumour bed, has the potential for postoperative haemorrhage, and is a contraindication for this technique.