Laparoscopic partial nephrectomy for multiple ipsilateral renal tumors using a tailored surgical approach.
Laparoscopic partial nephrectomy (LPN) is safe and effective for solitary renal masses, but its application to multiple ipsilateral renal tumors has been reported infrequently. We review our experience with LPN for multiple ipsilateral renal tumors to assess its role in current practice. We have managed seven patients with multiple ipsilateral renal tumors with LPN. Of the patients, four had an imperative indication for nephron-sparing surgery. Among the 16 tumors resected, with a mean size of 2.1 cm, 9 (in five patients) were renal cell carcinoma on final pathology. LPN was performed without hilar clamping in four patients (no-clamp group), and with hilar clamping and a sutured bolster in three patients (clamp-suture group). The no-clamp group had a lower mean operative time than the clamp-suture group (185 vs. 225 minutes), similar mean estimated blood loss (363 vs. 417 mL), and shorter hospital stay (1.8 vs. 3 days). The only complication was an intraoperative hemorrhage necessitating blood transfusion, and there was one focal-positive margin, both in patients in the clamp-suture group. Among the five patients with cancer, there have been no local recurrences or metastases during a mean radiographic follow-up of 48 months. LPN, with a tailored approach that spares some patients from renal ischemia, appears to be safe and effective in this small series of selected patients with multiple ipsilateral renal tumors.