CLAMPLESS LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR HILAR TUMOR

Abstract

Video shows a case of a clampless LPN for the treatment of hilar renal tumor. A 65 years old male presented at our institution with hilar tumor of left kidney (55mm). Renal score was 11h and C index was 1.2. A transperitoneal approach was performed and hilar vessels are prepared in event that bulldog clamping may subsequently be needed. Intraoperative monitoring includes also BIS monitor™ and NICOM. A controlled hypotension is maintened at approximately 60 mmHg. The renal lesion is excised using Ligasuretm. Calyceal suture was performed with Monocryltm. . Renal parenchyma was repaired with Vicryl™ sutures arrested with absorbable clips and Hem-O-lok™. Hemopatch and Floseal were applied to resection bed. BMI, ASA score and tumor size were 26, II and 55mm, respectively. Operative time, blood loss, ∆Hb were 185 min, 400 ml, 2.8 gr/dl, respectively. No transfusion was required. The procedure was performed without clamping. Hospital stay was 6 days. No postoperative complications occurred. Histological evaluation revealed RCC pT1b, Furhman 2 with negative surgical margins. Clampless laparoscopic partial nephrectomy represents a safe and reproducible technique that allow to sparing renal parenchyma and preserve renal function also in challenging case as hilar tumor.