Thulium Laser-Assisted Versus Conventional Laparoscopic Partial Nephrectomy for the Small Renal Mass.

BACKGROUND AND OBJECTIVES

Laparoscopic partial nephrectomy (LPN) has gained acceptance as a minimally invasive treatment option for small renal masses (SRMs). Laser-assisted LPN (LLPN) provided a bloodless tumor excision without renal artery clamping owing to the excellent coagulative and hemostatic properties of the lasers. The primary aim of this study is to evaluate the technical feasibility and outcomes of 2-μm continuous thulium LLPN and conventional LPN (CLPN) in the treatment of patients with SRMs.

STUDY DESIGN/MATERIALS AND METHODS: A retrospective analysis was performed for the medical charts of 312 patients with SRMs who underwent minimally invasive nephron-sparing surgery in our institution between January 2013 and December 2017. All 36 LLPN patients were matched with 36 CLPN patients. Surgical data, complications, pathological variables, oncological, functional, and health-related quality of life (HRQoL) outcomes were reviewed.

RESULTS

The two groups were similar in demographic characteristics. The renal vessels were not clamped in the LLPN group. Compared with the CLPN group, patients in the LLPN group had shorter warm ischemia time (WIT) (0 vs. 12.4 minutes, P = 0.000), longer tumor resection time (9.5 vs. 2.2 minutes; P = 0.000), and decreased operative time (84.1 vs. 95.5 minutes, p = 0.029). There were no open conversions and no transfusion in both groups. Median follow-ups for LLPN and CLPN were 56.2 and 48.6 months, respectively. The complication rate, renal functional outcomes, local recurrence rates, recurrence-free survival rates, and SF-36 questionnaire score were similar between the two groups.

CONCLUSIONS

Although this matched pair study showed CLPN had a longer WIT and higher operative time, the oncological and functional outcomes of LLPN and CLPN were similar. Both LLPN and CLPN are viable treatment options for select patients with SRMs. Lasers Surg Med. © 2019 Wiley Periodicals, Inc.