UroToday - The Cleveland Clinic has previously reported convincing evidence of the effectiveness and efficacy of laparoscopic partial nephrectomy for central endophytic renal tumors.

This report from Israel corroborates these findings by comparing 53 patients, in which the tumor was central, to 159 patients with peripheral renal tumors. The central tumor patients were younger and had larger tumors than the peripheral tumor patient group. Arterial clamping was performed in 100% of the central tumors and 83% of the peripheral tumors with warm ischemia times longer, respectively (37 vs. 28 minutes, p>0.05; but within acceptable time ranges). Mean estimated blood loss and operative times were similar for the two groups; 320 vs. 360 cc and 126 vs. 118, minutes respectively. The central group had one patient who required conversion to open surgery, but the perioperative complication rates were similar, 9.4% vs. 8.4%, respectively. One central tumor patient did undergo open reoperation because the tumor was not removed at the laparoscopic procedure due to misleading renal lobulation and perirenal fat adhesions. The occurrence of this error can be reduced by the application of intraoperative laparoscopic ultrasound to confirm the tumor position at the time of excision. However, improved technology for intraoperative imaging would be most welcome!

This study further supports laparoscopic partial nephrectomy for central renal tumors by surgeons with adequate skills and expertise.

Nadu A, Kleinmann N, Laufer M, Dotan Z, Winkler H, Ramon J
J Urol. 2009 Jan;181(1):42-7
10.1016/j.juro.2008.09.014

Written by UroToday Contributing Editor Elspeth M. McDougall, MD, FRCSC, MHPE

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