Laparoscopic nephron-sparing surgery for solid renal masses using the ultrasonic shears

Objectives. To report our experience with laparoscopic nephron-sparing surg ery (NSS) for solid renal masses. Methods. Between August 1998 and December 1999, 15 patients with solid rena l masses underwent laparoscopic NSS at our institutions. Seven patients und erwent a transperitoneal approach and eight a retroperitoneal approach. The kidneys were fully mobilized to allow inspection of all renal parenchyma. The ultrasonic shears were used to divide the renal parenchyma around the t umor in all cases. Renal surface hemostasis was then accomplished by weldin g a piece of oxidized regenerated cellulose gauze to the transected renal s urface with the argon beam coagulator. Tumors were removed intact and sent for analysis of frozen section margin status. Results. Laparoscopic NSS was successfully completed without complications in all patients. The mean tumor size was 2.3 cm (range 0.8 to 3.5), mean op erative time was 170 minutes (range 105 to 240), and mean estimated blood l oss was 368 mt (range 75 to 1000). The final pathologic finding was renal c ell carcinoma in 12 patients and oncocytoma in 3 patients. All final surgic al margins were negative. Patients were hospitalized for a mean of 2.6 days (range 2 to 4). Conclusions. Laparoscopic NSS for small, solid renal masses can be performe d safely with a combination of the ultrasonic shears for renal parenchymal transection and argon beam coagulation and oxidized regenerated cellulose g auze for renal surface hemostasis. UROLOGY 56: 754-759, 2000. (C) 2000, Els evier Science Inc.