Clinical effectiveness of modified method of laparoscopic partial nephrectomy.

e15602 Background: Warm ischemia time (WIT) is the most important factor predicting postoperative renal function condition after laparoscopic partial nephrectomy (LPN). Methods: During 1 year (2012) 22 LPN was performed on T1 stage renal cell carcinoma (RCC) patients. Our current laparoscopic technique involves transperitoneal approach, atraumatic hilar clamping (in all patients), tumor excision by cold endoshears. In 12 cases (54.5%) pelvicaliceal system (PCS) of the kidney was opened. These patients underwent LPN modification, which consists of excluding of separate PCS suture repair of the kidney after tumor excision. This technique allowed reducing WIT. Tumor bed excision was sutured using “sliding clip” technique without using any addition hemostatic materials. Control group consist of 10 (45.5%) patients whose PCS were not opened during LPN. Results: Mean age in the main and control groups was 59.3±10.6 years (range 42-77) and 52.5±11.7 years (range 33-68), mean tumor size – 39.3±7.5 mm (range 29-57) and 39.5±7.5 mm (range 25-52), mean RENAL nephrometry sum - 7.6±1.2 (range 6-10) and 6.8±0.9 (range 5-8), mean WIT – 12.6±2.3 min.(range 9-16) and 11.3±3.1 (range 6-15), mean blood loss – 207.5±237.9 ml (range 50-800) and 97±32.7 ml (range 50-150) respectively. In all 12 cases PCS defect was up to 2 cm. Conversion was performed in one case with RENAL nephrometry sum 10 and one kidney lost due to complexity of resection. Mean follow up was 5.4±3.1 month (range 1-10). Intraoperative hemorrhage was in 2 main group patients. Delayed hemorrhage, urine leak, postoperative renal failure did not occur. All patients confirmed RCC, and all of them had negative inked surgical margins for cancer. Conclusions: Thus, use of modified technique of LPN allowed carrying out difficult partial nephrectomies (up to 10 RENAL nephrometry sum) with no significant deference of WIT (p=0.334 Mann Whithitney U-test) from more simple LPN (without opening PCS). This explains absence of kidney injury in the postoperative period. We suppose, that meticulous suture repair of a tumor bed using “sliding clip” technique with defects of PCS up to 2 cm is safe, considered urine leak development. This approach will allow to expand indications to LPN.