Laparoscopic Partial Nephrectomy: Points of Technique

John M. Varkarakis, MD, PhD, Richard E. Link, MD

Product Details
Product ID: ACS-2276
Year Produced: 2004
Length: 10 min.


Laparoscopic partial nephrectomy for renal cell carcinoma is technically challenging due to the need for complete excision of the tumor without ischemic injury. Expert videotape analysis and critique benefits laparoscopic skills of training urologist. During the period from May 1998 to September 2003, over 100 laparoscopic partial nephrectomies were performed at our institution. We reviewed videotapes recorded during these procedures and compiled a series of vignettes to demonstrate the key components of this procedure such as hilar vascular control, tumor resection, collecting system reconstruction and hemostatic closure of the renal parenchyma. Patients undergoing laparoscopic partial or radical nephrectomy had similar lengths of hospitalization and rates of blood transfusion and perioperative complications. Surgical technique varies according to tumor location, renal anatomy and surgeon's preference. For all but the most exophytic tumors, however, we prefer to clamp the hilar vessels prior to tumor excision. We do not generally perform renal cooling and the average warm ischemic time using these techniques was <30 minutes in our series. Various methods for vascular control are demonstrated including the use of laparoscopic bulldog and Satinsky clamps. Both wedge resection and true hemi-nephrectomy are presented and examples of selective segmental arterial clamping are shown. Watertight closure of the renal collecting system is performed efficiently with the help of the Lapraties. Emphasis is placed on hemostasis of the renal parenchyma after tumor resection with the help of hemostatic bolster, sealants and a combination of interrupted and running sutures. Although technically demanding, laparoscopic partial nephrectomy can be performed safely and effectively even for large renal tumors when proper technique is applied. These techniques have allowed us to successfully achieve complete tumor resection without ischemic injury.