Experimental And Clinical Study Of The Laparoscopic Partial Nephrectomy

Partial nephrectomy has been utilized in the management of tumor in solitarykidney, tumor with contralateral kidney compromised by a benign disease ,bilateralrenal tumor and regional or segmental benign disease of kidney. Because of the favorable results obtained in terms of patient survival, tumor control and complication rates, the indications have extended to include patients with small tumor and a normal contralateral kidney. Laparoscopic partial nephrectomy as a miminal-invasional alternation of open partial nephrectomy with the virtue of less injury and quick recovery now has gained the enthusiasm. But because of the technical problem such as hemostasis and closure of the collecting system, this procedure has not been widely applied in clinical. We present our experience with 2 patients and 2 porcine which underwent laparoscopic partial nephrectomy to evaluate the feasibility and security of this procedure.Materials and methods1. Experiment part: 2 pig underwent laparoscopic partial nephrectomy. 30% renal parenchyma were resected during the procedure. Regional renal vascular control,short time renal hilar control monopolar electric coagulation, laparoscopic suture, hemostasis gauze and fibrin glue were applied to achieve complete hemostasis on the surface of the kidney. Laparoscopic suture and fibrin glue were applied to close the collecting system. Intraoperative time, blood loss, renal hilar control time, postoperative complication , and the result of IVP, exploratory laparotomy and pathology examination were observed.2. Clinical part: During 2002.11-2002.12, 2 patient underwent laparoscopic partial nephrectomy. Renal hilar control, monopolar electric coagulation, laparoscopic suture, hemostasis gauze and fibrin glue were applied to achieve complete hemostasis on the cut surface of the kidney. Laparoscopic suture and fibrin glue were applied to close the collecting system. Intraoperative time, blood loss, renal hilar control time, complication postoperative, hospital stay and the follow up 5 months postoperative were observed. Results1. Experimental part Both experiments were successful. Mean operating time was 132 min. Mean renal hilar control time was 10 min. Mean blood loss was 565 ml. Mean drainage postoperative was 105 ml, no complication postoperative. IVP and pathology examination shows function of the kidney were well preserved.2. Clinical part Both procedures were successful. Mean operating time was 235 min. Mean renal hilar control time was 25 min. Mean blood loss was 475ml. No postoperative complication. Mean hospital stay was 8 days . No tumor recurrent in follow up 4 months postoperatively.Conclusion1. Laparoscopic partial nephrectomy could undergo in human and porcine safely.2. Renal hihar control and laparoscopic suture combination with hemostasis gauze and fibrin glue could be effective in achieving complete hemostasis on the cut surface of kidney.3. Regional renal vascular control combination with hilar control could prolong the time of achieving complete hemostasis on the cut suface of kidney make theprocedure easier, and decrease the time of hilar control thus decrease the risk of damage to renal function.4. The proficient skill of laparoscopic suture plays the key role in achieving the success of the procedure as an effective method of intraoperative hemostasis and closure of the collecting system.5. It is necessary of combination with multiply hemostasis method in acheving the hemostasis in laparscopic partial nephrectomy.