Song Shiyu, Zhang Hongxian, Ma Lulin, Huang Yi, Zhao Lei, Wang Guoliang, Lu Jian, Zhang Shudong
Department of Urology, Peking University Third Hospital , Beijing, China .
J Endourol. 2015 Sep;29(9):1038-43. doi: 10.1089/end.2015.0064. Epub 2015 Jul 2.
To present preliminary experience of "renal pedicle rotation" method in retroperitoneal laparoscopic partial nephrectomy (RLPN) for renal ventral tumors.
A retrospective analysis of renal surgery database about patients undergoing RLPN was conducted. We identified 14 consecutive cases of all the surgeries from December 2013 to October 2014 with renal ventral tumors. The 14 surgeries were all in the application of renal pedicle rotation method, an intraoperative skill in which surgeons rotates the kidney on renal pedicle axis after separating renal artery and vein for a better tumor exposure.
A total of 14 patients underwent RLPN. All surgeries were successful without conversion to radical nephrectomy or open partial nephrectomy. The mean operative time was 171.1±47.2 min (range 83-246), the mean warm ischemia time was 15.9±9.8 min (range 7-35) and the mean estimated blood loss was 89.3±102.2 mL (range 10-300). Mean postoperative hospital stay was 6.2±1.9 days (range 4-10) and mean retroperitoneal drainage was 4.2±1.4 days (range 2-8). No intraoperative complications occurred. Postoperative complications developed in four patients. All patients had negative margins and pathological examination revealed 10 (71.4%) clear cell carcinomas, two (14.2%) epithelial renal angiomyolipoma, one (7.1%) papillary carcinoma and one (7.1%) nephrotuberculosis. The review of the early oncologic outcomes revealed no local recurrence and distant metastasis.
The renal pedicle rotation method might be a feasible and safe procedure to get a better tumor exposure for incision and suture in renal ventral tumors RLPN surgeries with acceptable postoperative outcomes.
介绍“肾蒂旋转”法在腹腔镜后入路肾部分切除术（RLPN）治疗肾腹侧肿瘤中的初步经验。
对接受RLPN手术患者的肾脏手术数据库进行回顾性分析。我们确定了2013年12月至2014年10月期间连续进行的14例肾腹侧肿瘤手术。这14例手术均采用肾蒂旋转法，即外科医生在分离肾动脉和静脉后，沿肾蒂轴旋转肾脏以更好地暴露肿瘤的一种术中技术。
共有14例患者接受了RLPN手术。所有手术均成功，无一例转为根治性肾切除术或开放性肾部分切除术。平均手术时间为171.1±47.2分钟（范围83 - 246分钟），平均热缺血时间为15.9±9.8分钟（范围7 - 35分钟），平均估计失血量为89.3±102.2毫升（范围10 - 300毫升）。术后平均住院时间为6.2±1.9天（范围4 - 10天），平均腹膜后引流时间为4.2±1.4天（范围2 - 8天）。术中无并发症发生。4例患者出现术后并发症。所有患者切缘阴性，病理检查显示10例（71.4%）为透明细胞癌，2例（14.2%）为上皮样肾血管平滑肌脂肪瘤，1例（7.1%）为乳头状癌，1例（7.1%）为肾结核。早期肿瘤学结果评估显示无局部复发和远处转移。
肾蒂旋转法可能是一种可行且安全的方法，可为肾腹侧肿瘤RLPN手术中的肿瘤切除和缝合提供更好的暴露，术后结果可接受。
