Nephron-sparing surgery has become standard practice in treating small renal lesions. Laparoscopic partial nephrectomy for tumors near the renal hilum can be especially challenging to approach. Vascular injury and prolonged warm ischemia time are significant concerns. Early anatomic dissection and prospective control of perforating vessels emanating from the renal hilum prior to vascular clamping may be used as a technique to minimize warm ischemia time.

We present two cases of laparoscopic partial nephrectomy for tumors near the renal hilum demonstrating this technique. Case 1 is an 80 year old male with a 3.4 cm left renal tumor located inferior to the renal hilum. Case 2 represents a 55 year old female with a 4 cm tumor near the renal hilum with a significant intraparenchymal component.

Laparoscopic partial nephrectomy with pre-emptive anatomic dissection was performed successfully in both patients. Warm ischemia time for case 1 and case 2 was 13 minutes and 33 minutes, respectively. There were no intraoperative complications for these two cases. In both cases, blood loss was less than 100 milliliters. Margins of resection were negative for both cases. Compared to pre-operative indexes of glomerular filtration rate (MDRD), renal function was unchanged on post-operative follow-up.

Pre-emptive anatomic dissection and vascular control can be accomplished safely and is feasible when approaching tumors near the renal hilum during laparoscopic nephron-sparing surgery. This technique may help to limit time needed for tumor resection and simplify reconstruction during warm ischemia.