Guliev B G, Yagubov Kh Kh
Department of Urology, I.I. Mechnikov North-Western State Medical University, St. Petersburg, Russia.
Urologiia. 2017 Dec(6):96-100.
Laparoscopic resection of upper pole kidney tumors is a technically challenging procedure. When tumors are located on the dorsal side of the kidney, the renal-rotation technique may facilitate laparoscopic partial nephrectomy.
To present the technique and results of laparoscopic partial nephrectomy (LPN) for tumors of the upper pole of the kidney with its rotation around the renal hilum.
The study presents a retrospective analysis of the results of 12 patients who underwent LPN for upper pole kidney tumors using the renal-rotation technique. The kidney with the renal hilar vessels and the upper third of the ureter were mobilized using a transperitoneal access. Then the kidney was rotated over its pedicular axis so that the upper pole was located inferiorly. As a result, the posterior upper pole tumor was located anteriorly, thereby facilitating its resection. After removing the tumor and confirming homeostasis, the kidney was returned to its original position.
The results of LPN using this technique were successful in all 12 patients. The mean operative time was 120+/-35.0 (90-210) min, the warm ischemia time was 14.5+/-7.8 (10-26) min, and the blood loss was 120.0+/-65.5 (60-300) ml. The intraoperative complication occurred in 1 (8.3%) patients, postoperative complications were observed in 3 patients. Histopathology showed that 11 (91.7%) patients had renal cell carcinoma and one (8.3%) had angiomyolipoma. Analysis of early (18.6+/-5.0 months) oncological outcomes showed no local recurrence and distant metastases.
With dorsally located upper pole kidney tumors, the renal-rotation technique facilitates the performance of LPN and minimizes the risk of intra- and postoperative complications. This method requires the maximum mobilization of the kidney along with the renal hilar vessels and the upper third of the ureter to rotate it for optimal resection conditions.
腹腔镜下上极肾肿瘤切除术是一项技术要求较高的手术。当肿瘤位于肾脏背侧时，肾旋转技术可能有助于腹腔镜下部分肾切除术。
介绍围绕肾门旋转的腹腔镜下上极肾肿瘤部分切除术（LPN）的技术及结果。
本研究对12例行肾旋转技术的上极肾肿瘤LPN患者的结果进行回顾性分析。采用经腹入路游离包含肾门血管及输尿管上三分之一的肾脏。然后将肾脏绕其蒂轴旋转，使上极位于下方。结果，上极后方的肿瘤位于前方，便于切除。切除肿瘤并确认止血后，将肾脏恢复至原位。
所有12例患者采用该技术行LPN均获成功。平均手术时间为120±35.0（90 - 210）分钟，热缺血时间为14.5±7.8（10 - 26）分钟，失血量为120.0±65.5（60 - 300）毫升。术中并发症发生在1例（8.3%）患者，术后并发症观察到3例。组织病理学显示，11例（91.7%）患者为肾细胞癌，1例（8.3%）为肾血管平滑肌脂肪瘤。早期（18.6±5.0个月）肿瘤学结果分析显示无局部复发及远处转移。
对于位于背侧的上极肾肿瘤，肾旋转技术有助于LPN的实施，并将术中及术后并发症风险降至最低。该方法需要最大限度地游离肾脏及其肾门血管和输尿管上三分之一，以便旋转肾脏创造最佳切除条件。
