Abstract：Objective: To investigate the safety and feasibility of retroperitoneal laparoscopic parenchyma-incised along Brodel line and tumor enucleation for complete endophytic renal tumors around the renal sinus. Methods: A total of 21 patients underwent retroperitoneal laparoscopic parenchyma-incised along Brodel line and tumor enucleation during January 2012 to December 2015. There were 13 males and 8 females with a median age of 50 (24-76 ) years old and mean BMI of 25.8 (20.9-29.8) kg/m2. The pre-operative GFR of the affected kidney was 36.2(30-43)mL·min-1·1.73 m-2). The median tumor diameter was 2.0 (1.2-2.5) cm. Pre-operative CT scan or MRI scan showed these renal tumors were complete endophytic and located around renal sinus, closed to the collecting system. The mean R.E.N.A.L. score of these tumors was 9.4 (9-10) p. After the blocking of renal ar-tery and renal vein, ice water mixture was infused to reduce the kidney temperature twice. An incision on the Brodel line was made and then total tumor was freed and removed. 4-0 Quill string and then 1-0 Quill string were used to close the collecting system, and to suture the kidney. Results: All the surgeries were successful with a mean operation time of 94min (60-150 min) and a mean warm ischemia time of 28.4 min (24-40 min). The mean estimated blood loss was 63 mL (20-200 mL). The mean postoperative hospital stay was 5.5 days (5-6 days). No positive margin was found. Hematuria occurred in one patient and disappeared three days later. No bleeding and urinary leakage occurred. The pathological diagnosis confirmed 16 cases of clear cell renal cell carcinoma, 4 cases of papilary and one case of reninoma. The mean post-operative GFR of the affected kidney 3 months after surgery was 31.5 (24-38) mL·min-1·1.73 m-2), slightly lower than the preoperative value. No recurrence or metastasis was observed during a median follow-up of 20 (4-36) months. Conclusions: It is safe and feasible for retroperitoneal laparoscopic parenchyma-incised along Brodel line and tumor enucleation for complete endophytic renal tumors around the renal sinus. And this operation can protect maximum volume normal renal parenchyma. Its tumor control is satisfactory in a short follow-up period, however, further investigation with a larger population group and longer follow up period will be meaningful.
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