Mauricio Rubinstein

Laparoscopic partial nephrectomy for centrally located renal tumors.

PURPOSE LPN is frequently reserved for small, peripherally located tumors. Centrally located tumors typically require complex intracorporeal suturing and reconstruction with hilar clamping, which is a laparoscopically advanced maneuver given the constraints of renal ischemia. We retrospectively compared our experience with central vs peripheral tumors treated with LPN. MATERIALS AND METHODS Between January 2001 and March 2004, 363 patients underwent LPN for tumor. The tumor was located centrally in 154 patients and peripherally in 209. Central tumors were defined as tumors centrally extending into the kidney in direct contact with or invading into the pelvicaliceal system and/or renal sinus on preoperative 3-dimensional computerized tomography. Lesions with no contact with the pelvicaliceal system were classified as peripheral. Preoperative, intraoperative, postoperative and pathological data were compared. RESULTS Central tumors were larger (median 3 vs 2.4 cm, p < 0.001) and had larger specimens at surgery (median 43 vs 22 gm, p < 0.001) than peripheral tumors. Although blood loss was similar (median 150 cc), central tumors required longer warm ischemia time (median 33.5 vs 30 minutes, p < 0.001), operative time (median 3.5 vs 3 hours, p = 0.008) and hospital stay (median 67 vs 60 hours, p < 0.001). A positive cancer margin occurred in 1 patient per group. Median postoperative serum creatinine was similar (1.2 vs 1.1 mg/dl). Intraoperative and late postoperative complications were comparable. However, more early postoperative complications occurred in the central group (6% vs 2%, p = 0.05). CONCLUSIONS LPN for central tumors can be performed safely by an experienced laparoscopic surgeon with perioperative outcomes comparable to those of peripheral tumors. Given the requisite laparoscopic expertise, indications for LPN should be expanded to include centrally located tumors.

Laparoscopic partial nephrectomy for cancer: techniques and outcomes

Open partial nephrectomy is the gold standard nephron-sparing treatment for small renal tumors. Technical aspects of laparoscopic partial nephrectomy have evolved considerably, and the technique is approaching established status at our institution. Over the past 4 years, the senior author has performed more than 400 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique and review contemporary outcome data.

Energy sources for laparoscopic partial nephrectomy: critical appraisal

Laparoscopic partial nephrectomy (LPN) has emerged as a viable alternative for the conventional open nephron-sparing surgery (NSS). So far, an adequate renal parenchymal cutting and hemostasis, as well as caliceal repair remains technically challenging. Numerous investigators have developed techniques using different energy sources to simplify the technically demanding LPN. Herein we review these energy sources, discussing perceived advantages and disadvantages of each technique.

Laparoscopic surgery in urological oncology: brief overview

The authors report the experience of a high-volume center with laparoscopic surgery in urological oncology, as well as a review of other relevant series. Laparoscopic outcomes in the treatment of adrenal, kidney, upper tract transitional cell carcinoma, bladder, prostate, and testicular malignancy are described in this review. Specific considerations as complications and port-site recurrence are also addressed. The authors concluded that the intermediate-term oncological data is encouraging and comparable to open surgery.