Objective To externally validate and modify an existing technical strategy of prospectively tailoring one's operative approach to minimally invasive partial nephrectomy (MIPN). Patients and Methods We prospectively applied the model used in this strategy to evaluate 44 consecutive patients who underwent MIPN between August 2006 and August 2008. Patients were divided into four groups according to tumour depth of penetration or entry into the collecting system. Group 1 (n= 9, 20%) underwent MIPN without clamping the renal hilum or parenchymal suturing. Group 2 (n= 2, 5%) underwent clamping but not suturing. Group 3 (n= 21, 48%) underwent clamping and suturing. Group 4 (n= 12, 27%) underwent clamping, renal sinus reconstruction and suturing. We then assessed the peri- and postoperative outcomes, tumour histopathology and complications for each group. Results All patients had successful procedures according to the strategic model. The mean operative time was 246 (105-420) min and the mean estimated blood loss was 177 (25-1000) mL. When patients were stratified by clamping vs no clamping, the only significant variables between the two groups were operative time (245 vs 203 min) and pathology (83% vs 44% malignant). Six patients in the clamping group had postoperative complications (three had delayed bleeding, two had pneumonia, and one had infected urinoma) vs one patient in the no-clamping group who had prolonged ileus (P > 0.05). Mean hospital stay was comparable in both groups (2.6 vs 3 days). Conclusion Minimally invasive partial nephrectomy can be tailored according to tumour location, avoiding unnecessary clamping and/or suturing of the kidney without negatively affecting treatment outcomes.
- kidney neoplasms
- renal cell