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2016 ; 12
(5
): 3799-3803
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Improved laparoscopic nephron-sparing surgery for renal cell carcinoma based on
the precise anatomy of the nephron
#MMPMID27895733
Guo G
; Cai W
; Zhang X
Oncol Lett
2016[Nov]; 12
(5
): 3799-3803
PMID27895733
show ga
The aim of the present study was to investigate a method of laparoscopic
nephron-sparing surgery (LNSS) for renal cell carcinoma (RCC) based on the
precise anatomy of the nephron, and to decrease the incidence of hemorrhage and
urinary leakage. Between January 2012 and December 2013, 31 patients who
presented to the General Hospital of the People's Liberation Army (Beijing,
China) were treated for RCC. The mean tumor size was 3.4±0.7 cm in diameter
(range, 1.2-6.0 cm). During surgery, the renal artery was blocked, and
subsequently, an incision in the renal capsule and renal cortex was performed, at
3-5 mm from the tumor edge. Subsequent to the incision of the renal parenchyma,
scissors with blunt and sharp edge were used to separate the base of the tumor
from the normal renal medulla, in the direction of the ray medullary in the renal
pyramids. The basal blood vessels were incised following the hemostasis of the
region using bipolar coagulation. The minor renal calyces were stripped carefully
and the wound was closed with an absorbable sutures. The arterial occlusion time,
duration of surgery, intraoperative bleeding volume, post-operative drainage
volume, pathological results and complications were recorded. The surgery was
successful for all patients. The estimated average intraoperative bleeding volume
was 55.7 ml, the average surgical duration was 95.5 min, the average arterial
occlusion time was 21.2 min, the average post-operative drainage volume was 92.3
ml and the average post-operative length of hospital stay was 6.1 days. No
hemorrhage or urinary leakage was observed in the patients following the surgery.
LNSS for RCC based on the precise anatomy of the nephron was concluded to be
effective and feasible. The surgery is useful for the complete removal of tumors
and guarantees a negative margin, which may also decrease the incidence of
hemorrhage and urinary leakage following surgery.