The Application of Internal Suspension Technique in Retroperitoneal Laparoscopic Partial Nephrectomy for Renal Ventral Tumors

Abstract

Objective To evaluate the feasibility of an internal suspension technique in retroperitoneal laparoscopic partial nephrectomy for the management of renal ventral tumors. Methods Between January 2013 and July 2016, a total of 145 patients underwent retroperitoneal laparoscopic partial nephrectomy with or without internal suspension technique. For patients who underwent internal suspension technique, the surgeons preserved the external fat of the renal tumor as a suspension traction measure when separating the kidney. Propensity score matching (PSM) was performed according to age, gender, body mass index, tumor size, tumor location, and RENAL nephrometry score. Patient characteristics and intraoperative and postoperative outcomes were compared between the groups. Results After PSM, 32 patients treated with the internal suspension technique were compared with 32 cases treated without such technique. Baseline characteristics were statistically similar for the cohorts. The use of our new technique resulted in shorter warm ischemia time (WIT: 15.0 versus 19.0 minutes, P = .002) and tumor resection time (4.0 versus 7.5 minutes, P < 0.001). The rate of WIT >25 minutes decreased (6.3% versus 25%, P = .04) and the trifecta outcomes were significantly improved (87.5% versus 62.5%, P = .02). Conclusion Internal suspension technique is a feasible and safe procedure in retroperitoneal laparoscopic partial nephrectomy for renal ventral tumors.

Laparoscopic aspirator bracket: a new instrument facilitating the aspiration and exposure of operative field simultaneously in laparoscopic nephron-sparing surgery

“…In addition, operation time, especially the warm ischemia time, is very limited ( 13 ). In such situations, anatomic exposure and liquid aspiration are of equal importance ( 14 ). However, to aspirate liquid and expose the anatomic plane simultaneously, such as the plane between the pseudocapsule and the renal parenchyma, challenges hand skill.…”