Laparoscopic partial nephrectomy for bilateral complex renal masses

Abstract

Objective: In this video article, we wanted to convey our experience and intraoperative subtleties with bilateral laparoscopic partial nephrectomy (LPN) for complex bilateral sporadic renal tumors (SRT). Patient and surgical procedure: Computed tomography (CT) of 65-year-old female patient revealed a 73 mm lower pole mass in the right kidney, accompanied with multiple stones which the largest one measuring 17 mm in the lower pole and renal pelvis, and an endophytic 2 cm mass in the anterior aspect of the hilum of the left kidney. RENAL nephrometry score was 10 for both sides. Preoperative creatinine level was 0,55 mg/dl. Bilateral LPN, prioritizing right side, was planned. Under global ischemia, the mass was excised with cold scissors, and stones were extracted with a grasper from the opened collecting system. After the base of the defect and the collecting system were repaired with 3/0 monofilament absorbable suture, Floseal® was applied. The patient was rescheduled for a left LPN 6 weeks after After 6 weeks, the patient who had an uneventful course following the initial operation was scheduled for left LPN. The mass was enucleated under selective ischemia after similar operative steps as on the right side. Mass excision, renorrhaphy, and removal of the specimen were performed similarly to the right side. Results: For the right side, insufflation and warm ischemia time (WIT) were 150 and 18 min, respectively and the estimated blood loss (EBL) was 300cc. For the left side, insufflation and selective ischemia time were 110 and 36 min, respectively and EBL was 120cc. There were no postoperative complications on either side. Pathology results revealed clear cell renal cell carcinoma (ccRCC), WHO grade 2 (stage pT2a, pT1a for the right and left sides, respectively), with negative surgical margins on both sides.There has been no recurrence or metastases by the end of the first year of follow-up with a 0,79 mg/dl creatinine level. Conclusion: In bilateral high complexity SRTs, it seems that PN for both tumors is the best solution, although standard care has not been established yet. Staged LPN might be feasible for the preservation of both oncological and functional outcomes.

Keywords

• Kidney tumor
• Laparoscopy
• Nephron sparing surgery
• Complex renal mass