Laparoendoscopic single-site partial nephrectomy without hilar clamping using a microwave tissue coagulator.

Kawai, Noriyasu; Yasui, Takahiro; Umemoto, Yukihiro; Kubota, Yasue; Mizuno, Kentaro; Okada, Atsushi; Ando, Ryosuke; Tozawa, Keiichi; Hayashi, Yutaro; Kohri, Kenjiro

PURPOSE To report our initial experience and evaluate the possibility of nonhilar clamp laparoendoscopic single-site (LESS) partial nephrectomy by using a microwave tissue coagulator. PATIENTS AND METHODS From December 2010 to May 2012, all patients with an exophytic, solitary, enhancing small (≤4.0 cm) renal mass were chosen to receive the study treatment. A multichannel port provided both a retroperitoneal and transperitoneal approach. A rigid, articulating apparatus was used to perform dissection, exposure of tumor, tissue coagulation, and resection without hilar clamping. Pathologic and hematologic data, subjective evaluation of pain, and scar appearance were analyzed. RESULTS Nonhilar clamp LESS partial nephrectomy by using a microwave tissue coagulator was performed in seven patients (mean operative time, 208 min; mean blood loss, 39 mL; mean renal mass size, 1.7 cm); one procedure with uncontrolled bleeding needed to be converted to conventional laparoscopic partial nephrectomy. No transfusion was necessary. Pathologic investigation demonstrated six renal-cell carcinomas and one oncocytoma. The hemoglobin level decreased by a mean of 1.1 g/dL. Patients did not complain about pain, and they had great satisfaction with the results. The mean duration of hospital stay was 13.8 days. CONCLUSIONS LESS partial nephrectomy without hilar clamping by using a microwave tissue coagulator is possible for renal masses, confers postoperative outcomes comparable to the standard counterpart, and assures patient satisfaction. By use of a microwave tissue coagulator, additional trocars were not necessary, and LESS partial nephrectomy could be accomplished through a single port, which reduced invasion and increased the cosmetic satisfaction of the patients.