1Department of Urology, Provincial Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fujian Provincial Jinshan Hospital, Fuzhou 350001, China
Abstract：Objective: To investigate the safety and feasibility of laparoscopic partial nephrectomy (LPN) guided by laparoscopic ultrasonography (LUS) for totally intrarenal tumours (TIT) and para-hilumrenal tumors (PHT). Methods: The clinical data of 20 patients who underwent LPN guiding by LUS during May 2015 to May 2016 were retrospectively analyzed. After dissecting the renal artery, and exposing the kidney, LUS was used to identify the tumor. The tumor margin was marked on the ranal capsule with a hook according to the US images. After clamping the renal artery, ice water mixture was infused to decrease the kidney temperature. The tumor could be resected from the involved kidney completely, and renal repair was performed. Results: All the operations were successful with mean operation time of 134.6 min (90-240 min). Mean warm ischemia time (WIT) via the retroperitoneal approach was 25.3 min (18-38 min), and 24.0 min (19-29 min) via the transperitoneal approach. Mean estimated blood loss was 123.3 mL (20-300 mL). The mean postoperative hospital stay was 8.5 days (6-10 days). Hematuria occurred in two patients and disappeared spontaneously on the postoperative day 3 and 5 respectively. No late bleeding and urine leakage occurred. The pathological diagnosis confirmed 10 cases of clear cell renal cell carcinoma, 5 cases of papillary carcinoma, 4 cases of angiomyolipoma, and one case of metanephric adenoma. Mean GFR was 48.6 mL·min-1·1.73 m-2 (33.8-61.0 mL·min-1·1.73 m-2) before operation, and 41.1 mL·min-1·1.73 m-2 (28.6-51.7 mL·min-1·1.73 m-2) at 3rd month postoperation. All patients had negative tumor margins and were free of disease recurrence and metastasis during a mean follow-up period of 8.4 (3-12) months. Conclusions: It is safe and feasible for LPN guided by LUS for TIT and PHT. The use of LUS allows the surgeon to optimize tumor identification, reduce renal vascular damage and preserve the kidney function.
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