Nefrectomía parcial laparoscópica

objetives: to analyze the surgical and oncologic outcome of prospective experience with laparoscopic partial nephrectomy. we describe the surgical technique and mid term oncological results achieved. material and methods: 60 patients were operated with this technique between june 2005 and june 2009. the mean age of patients was 58.9 [38-77] years, being 40 (66.7%) males and 20 (33.3%) women. the average bmi was 26.8 [18-40]. laterality was 28 (46.7%) tumors rights and 32 (53.3%) left, being located in the upper pole in 14 (23.3%) patients, in the middle third in 13 (21.7%) in the lower pole in 22 (36.7%) and hiliar region in 11 (18.3%). in 23 cases (38.3%) tumors were located in the anterior valve, in 24 (40%) in posterior valve, in 10 (16.7%) at the outer edge and 3 (5%) at the inner edge. the average size tumor on ct was 3.3 [1-6.4] cm and in the surgical specimen 3.1 [1.2-7] cm. results: the mean operative time was 107.17 [50-185] min, with a warm ischemia time of 33 [0-70] min. in 56 cases (93.3%) had a single artery and 4 (6.7%) cases had 2 arteries. the artery was clamped alone in 15 patients (25%), artery and vein in 44 (73.3%) and no clamping was performed in 1 (1.7%). we repaired the urinary tract in 32 patients (53.3%), leaving ureteral catheter in all patients. 20% of patients (12) required transfusion. intraoperative complications occurred in 5 patients (8.7%). these were: 1 splenic injury requiring splenectomy (1.7%), 1 tear in the vena cava, sutured laparoscopically (1.7%) and 3 cases of bleeding due to bulldog malfunction (5%). postoperative complications occurred in 11 patients (18.7%) and these were: 1 wall hematoma that required reoperation (1.7%), 1 urinary fistula ending in renal atrophy and subsequent nephrectomy (1.7%), 3 intracavitary hematomas hich resolved conservatively (5%), 1 arteriovenous fistula that needed embolization (1.7%), 1 urinoma that was resolved with percutaneous drainage (1.7%) and 3 cases of postoperative fever (5%). margins