Complex laparoscopic partial nephrectomy for renal hilar tumors

Objectives. To evaluate our experience with laparoscopic partial nephrectomy (LPN) for tumors located adjacent to the renal hilum. Continued advances in laparoscopic technology and technique have made LPN feasible for increasingly anatomically complex tumors. Methods. A retrospective chart review was performed of all patients who underwent LPN at Washington University. We identified 8 patients who had undergone LPN between December 2001 and September 2004 for hilar tumors that were defined as those located within 5 mm of the renal hilar vessels. The data were retrospectively analyzed for parameters, including operative time, morbidity, and postoperative course. Results. LPN was successfully completed in all 8 patients without conversion to an open or hand-assisted approach. The indication for nephron-sparing surgery was elective in 6 patients and imperative in 2. The mean operative time was 3.0 hours (range 2.5 to 3.5), and the mean estimated blood loss was 188 mL (range 30 to 700). All patients had negative margins on the final pathologic examination. No intraoperative complications occurred. Nine postoperative complications developed in 6 patients. They included hemorrhage in 1, fever in 1, ileus in 1, urinary tract infection in 1, urine leak in 4, and transient postoperative neuropathy in 1 patient. Conclusions. With adequate laparoscopic experience, LPN for hilar tumors is a reasonable surgical option. In our experience, the procedure was associated with an increased risk of urine leak. Preoperative placement of a ureteral catheter to help delineate collecting system violations and routine postoperative stenting may reduce the incidence of this complication.