Department of Urology and Kidney Transplantation, Martin-Luther-University, Ernst-Grube-Strasse 40, Halle/Saale, Germany.
BJU Int. 2013 Jun;111(7):1091-8. doi: 10.1111/j.1464-410X.2012.11601.x. Epub 2013 Jan 29.
WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Laparoendoscopic single-site (LESS) surgery has proved to be immediately applicable in the clinical field, being safe and feasible in the hands of experienced laparoscopic surgeons in well-selected patients. All extirpative and reconstructive urological procedures have been described in the literature, but LESS partial nephrectomy (PN) is one of the most complex procedures and few studies have been published on this subject. The study describes a clampless technique for LESS PN, by reducing the blood pressure and increasing the intra-abdominal pressure of the pneumoperitoneum to 20 mmHg, timed to precisely coincide with excision of the tumour. This technique was found to be safe and feasible in the treatment of low-risk T1a RCC.
To describe the technique and report the surgical outcomes of clampless laparoendoscopic single-site (LESS) partial nephrectomy (PN) in the treatment of renal cell carcinoma (RCC) with low PADUA score.
Clampless LESS PN was performed in 14 patients with cT1a renal tumours. Indications to perform a clampless LESS PN were low-risk, laterally based renal tumours, located away from the renal hilum, with a PADUA score ≤7. Demographic data and peri-operative and postoperative variables were recorded and analysed. Kidney function was evaluated by measuring serum creatinine concentration and estimated glomerular filtration rate (eGFR) pre- and postoperatively and at 6-month follow-up.
The median operating time was 120 min and warm ischaemia time was zero in all cases. Only one early complication (Clavien grade 1) was recorded: one patient developed a flank haematoma which it was possible to treat by conservative therapy. Serum creatinine and modification of diet renal disease eGFR were not found to be significantly different pre- and postoperatively and at 6-month follow-up. Definitive pathological results showed 12 pT1a RCCs and two pT1a-chromophobe RCCs. All tumours were removed with negative surgical margins. All patients were satisfied with the cosmetic results. At a median (range) follow-up period of 12 (8-15) months, all patients were alive without evidence of tumour recurrence or port-site metastasis.
Clampless LESS PN is a safe and feasible surgical procedure in the treatment of low-risk T1a RCC, with excellent cosmetic results.
描述一种无夹闭技术，并报告其在低风险 PADUA 评分肾细胞癌（RCC）患者中应用于腹腔镜单部位（LESS）部分肾切除术（PN）的手术结果。
对 14 例 cT1a 肾肿瘤患者实施无夹闭 LESS PN。行无夹闭 LESS PN 的适应证为低危、外侧位、远离肾门的 RCC，且 PADUA 评分≤7。记录并分析患者的人口统计学数据以及围手术期和术后变量。通过术前、术后和 6 个月随访时测量血清肌酐浓度和估算肾小球滤过率（eGFR）来评估肾功能。
中位手术时间为 120 分钟，所有病例的热缺血时间均为 0。仅记录到 1 例早期并发症（Clavien 1 级）：1 例患者出现腰部血肿，经保守治疗后得以缓解。术前、术后和 6 个月随访时血清肌酐和改良肾脏病饮食研究组 eGFR 无显著差异。明确的病理结果显示 12 例 pT1a RCC 和 2 例 pT1a-嫌色细胞 RCC。所有肿瘤均以阴性切缘完整切除。所有患者对美容效果均满意。中位（范围）随访期为 12（8-15）个月时，所有患者均存活，无肿瘤复发或切口转移的证据。
无夹闭 LESS PN 是一种治疗低危 T1a RCC 的安全可行的手术方法，具有良好的美容效果。
