Right laparoscopic partial nephrectomy for a mesorenal tumor of the right kidney

Nowadays, with the accuracy of the modern imaging techniques, the diagnosis of incidental renal tumors has become increasingly frequent. These tumors are often small in size and minimally invasive procedures represent an optimal indication to perform nephron-sparing surgery (NSS). In addition, the oncological results are comparable to the open approach. This video shows a right laparoscopic partial nephrectomy in a 52-year-old woman.

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Right laparoscopic partial nephrectomy for a mesorenal tumor of the right kidney

Authors

T Piéchaud, OA D’Orazio, C Fraga

Abstract

Nowadays, with the accuracy of the modern imaging techniques, the diagnosis of incidental renal tumors has become increasingly frequent. These tumors are often small in size and minimally invasive procedures represent an optimal indication to perform nephron-sparing surgery (NSS). In addition, the oncological results are comparable to the open approach. This video shows a right laparoscopic partial nephrectomy in a 52-year-old woman.

Classification

basic techniques, contribution

Keywords

Right laparoscopic partial nephrectomy

Media type

Surgical video

Duration

14'51''

Publication

2009-11

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E-publication

WeBSurg.com, Nov 2009;9(11).
URL: http://www.websurg.com/doi-vd01en2785.htm

Right laparoscopic partial nephrectomy for a mesorenal tumor of the right kidney

1. Introduction 00'07''

In this video, we show our nephron-sparing surgical technique. We present the case of a 52-year-old woman, who had been incidentally diagnosed with a mesorenal tumor of the right kidney. Nowadays, with the use of modern imaging techniques, the diagnosis of incidental renal tumors has become more and more frequent. These tumors are often small in size and minimally invasive procedures represent an optimal indication to perform nephron-sparing surgery (NSS). This is based on the fact that, in addition to having comparable oncological results to open partial nephrectomy, it also has the advantages of laparoscopic procedures. On the other hand, partial laparoscopic nephrectomy is still considered to be a challenge for urologists.

2. Dissection of the perirenal fat, hilum, and kidney mobilization 00'56''

In the first step of the surgery, we use the transperitoneal approach to perform the dissection of the perirenal fat tissue in order to achieve a good exposure of the renal hilum for later clamping. This also allows to mobilize the kidney and to isolate the tumor for its posterior resection and reconstruction.

3. Clamping of the pedicle 03'12''

After its dissection, the renal pedicle is clamped en bloc. A straight Satinsky laparoscopic clamp is used for this maneuver.

4. Tumor exeresis 03'47''

In this step, we incise the kidney on the healthy tissue surrounding the tumor in order to obtain negative surgical margins. As we can see, when the renal hilum is successfully clamped, this translates into minimal bleeding of the surgical field, which is mostly due to a vascular backflow.

5. Reconstruction 07'35''

Once the exeresis of the tumor is completed, the reconstruction of the kidney is performed in two steps: the first step consists in the control of the small arteries and of any open calyces, with a 3/0 Monocryl running suture. The second step consists in the suture of the renal parenchyma using a 0 Vicryl interrupted suture and Hem-o-lock® clips.

6. Declamping and hemostasis control 13'44''

After declamping, any bleeding that may occur can be controlled by suture, or like in this case, by the use of Surgicell®.

7. End of the procedure 14'25''

An Endobag is used to retrieve the specimen. A drainage is left into the renal fossa.