Our Experience of Laparoscopic Partial Nephrectomy: Technique and Results
Keywords:laparoscopic partial nephrectomy, nephrometric score
Laparoscopic partial nephrectomy (LPN) is considered an effective modern minimally invasive surgical intervention and is an alternative to open partial nephrectomy (OPN) in the surgical treatment of kidney cancer.
The objective: to provide modern evidence of the effectiveness of LPN in the surgical treatment of patients and to describe the further evolution of this minimally invasive technique.
Materials and methods. We prospectively analyzed the data of 63 patients who underwent LPN for clinically localized kidney cancer since September 2015 to October2019 in the urology clinic of theNationalMilitaryClinicalHospital «GVKG» of the Ukrainian Ministry of Defense. LPN was performed using anOlympus endoscopic stand. Clinical data were obtained through a prospective analysis of surgical interventions, including intra- and postoperative results and complications. Descriptive statistical analysis and a multivariate logistic regression model were used to predict surgical outcomes.
Results. The average age of the patients was 60.7 years; the average preoperative tumor size was33.0 mm. According to the PADUA-scale, 22 (35.0 %) patients were categorized as low difficulty, 23 (36.5 %) to the intermediate difficulty category and 18 (28.5 %) to the high difficulty category. All patients had transperitoneal access. The average surgery time was 156 minutes. The average blood loss was 171 ml. Overall, significant postoperative complications occurred in 2 (3.2 %) patients (Clavien-Dindo >2). We did not find any statistically significant differences between pre- and postoperative level of creatinine (p<0.05). In general, optimal surgical results, including analysis of the surgical margin, degree of ischemia, and level of complications, were achieved in 44 (69.8 %) patients. During an average of 26 months of observation, only two local and two distant metastases were recorded. In the end, using the multivariate logistic regression model, it was revealed that the degree of complexity of the tumor was associated with a greater risk of obtaining a non-optimal surgical result.Conclusions. LPN is an effective minimally invasive alternative to OPN in the treatment of clinically localized renal cell carcinoma. We presented the current experience of the use of LPN in the surgical treatment of kidney cancer. LPN, as it turned out, is an effective and safe minimally invasive operation that provides optimal results in most patients with varying degrees of tumor complexity.
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